目的 通过与经皮克氏针撬拨复位比较,评价经皮血管钳捋拨复位联合弹性髓内针内固定治疗儿童桡骨颈O’Brien Ⅱ、Ⅲ型骨折的临床疗效.方法 将2014年1月至2016年1月南京医科大学附属儿童医院收治的62例儿童桡骨颈O’Brien Ⅱ、Ⅲ型骨折患儿纳入前瞻性研究对象.其中男38例,女24例;左侧42例,右侧20例;年龄4～14岁,平均8.4岁;均为新鲜骨折,受伤至手术时间8h至3d,平均1.6d.桡骨颈骨折采用O’Brien分型:Ⅱ型36例、Ⅲ型26例.根据采用复位方式的不同,术前应用随机数字表法将患儿随机分为血管钳组(32例,经皮血管钳捋拨复位)和克氏针组(30例,经皮克氏针撬拨复位).两组病例经皮复位骨折后均以弹性髓内针髓内固定.两组患儿术前一般资料差异无统计学意义(P＞0.05).两组患儿手术操作均由同一位副主任医师完成,术前准备及术后治疗、康复训练情况相同.记录并比较两组手术时间、术中C臂机透视次数、术中经皮复位的次数、骨折愈合时间、取内固定前1d进行的患肢肘关节功能Metaizeau标准评估结果.组间比较采用独立样本t检验,对计数资料采用非参数检验,其余采用x2检验.结果 62例患儿均获得随访,血管钳组32例,平均随访10.6个月;克氏针组30例,平均随访10.9个月.两组骨折患儿术后均骨性愈合.血管钳组手术时间、术中透视次数、经皮复位次数为(16±2.7)min、(5.4±2.2)次、(2.3±1.4)次少于克氏针组的(31±3.3)min、(13±3.4)次、(5.6±2.2)次.血管钳组在手术时间、术中C臂机透视次数、术中经皮复位的次数明显优于克氏针组(P＜0.05),差异均具有统计学意义.两组患儿在骨折愈合时间、取内固定前1d肘关节功能Metaizeau评估方面的差异无统计学意义(P＞0.05).随访过程中两组病例未发现骨不连、骨折再移位及医源性桡神经损伤等并发症发生,克氏针组术后出现1例桡骨近端骨骺发育不良.结论 与经皮克氏针撬拨复位比较,经皮血管钳捋拨复位能达到精准复位,操作顺手,简便易行,手术时间短,经皮复位次数少和术中对医护人员以及患儿的放射损伤小,同时可避免克氏针反复撬拨对桡骨近端骨骺造成的损伤.“,”Objective To evaluate the efficacy of percutaneous haemostat stroke-poking reduction plus close intramedullary nailing fixation versus percutaneous Kirshner-wire leverage for O’Brien Ⅱ/Ⅲ pediatric radial neck fracture.Methods From January 2014 to January 2016,a total of 62 children were operated for O’BrienⅡ/Ⅲ pediatric radial neck fractures due to falling from the height.There were 38 boys and 24 girls with an average operative age of 8.4 (4-14) years.The involved side was left (n =42) and right (n=20).According to the O’Brien classification scheme,the clinical types were Ⅱ (n=36) and Ⅲ (n=26).They were prospectively and consecutively randomized into haemostat group (n=32,percutaneous haemostat stroke-poking reduction plus elastic stable intramedullary nailing fixing) and Kirshnerwire group (n =30,percutaneous Kirshner-wire leverage plus elastic stable intramedullary nailing fixing).Two groups were statistically compared in terms of operative duration,frequency of intraoperative radiography,fracture healing and postoperative Metaizeau score of elbow.Results All operations were successfully completed.During an average follow-up period of 10.7 (6-19) months,there was no onset of puncture wound irffection ordisplacement of fracture fragment.All fractures demonstrated clinical and radiographic evidence of complete healing at an average of approximately 8 weeks.As compared with percutaneous Kirshner-wire leverage group,haemostat group achieved significantly shorter average operative duration [(16 ± 2.7) vs (31 ± 3.3) min],significantly lower average frequency of intraoperative radiography [(5.4 ± 2.2) vs (13 ± 3.4) times] and lower number of close reduction [(2.3 ± 1.4) vs (5.6 ± 2.2) times] (P＜0.05).No statistically significant differences existed in fracture healing time or postoperative Metaizeau score of elbow at the last follow-up (P＞0.05).There was no onset of such major complications as deep infections,neurovascular injuries,fracture displacement or residual deformity.There was one case of dysplasia of proximal epiphysis in Kirshner-wire group.Coclusions As compared with percutaneous Kirshner-wire leverage,percutaneous haemostat stroke-poking reduction may enhance the probability of successful reduction at an initial attempt,reduce the number of close reduction and shorten operative duration.Effective,simple,reliable and miniinvasive with few complications,this procedure also minimizes the radiological exposure of both children and medical staff.