闭合复位弹性髓内钉固定及切开复位克氏针固定对桡骨颈骨折患儿肘关节生物力学重建效果的影响观察  

Effect of closed reduction with elastic intramedullary nail and open reduction with Kirschner wire fixations on the biomechanical reconstruction of elbow joints in children with radial neck fractures

作　　者：李涛[1] 漆伟[2] 郭明钧[1] LI Tao;QI Wei;GUO Ming-jun(Fourth Ward of Orthopedics,Chongqing 400010,China;Hospital Office,Chongqing Traditional Chinese Orthopedic Hospital,Chongqing 400010,China)

机构地区：[1]重庆市中医骨科医院骨科四病区,重庆400010 [2]重庆市中医骨科医院医院办公室,重庆400010

出　　处：《临床和实验医学杂志》2020年第20期2208-2212,共5页Journal of Clinical and Experimental Medicine

基　　金：重庆市医学科研计划项目(编号:2013-2-190)。

摘　　要：目的观察闭合复位弹性髓内钉固定及切开复位克氏针固定对桡骨颈骨折患儿肘关节生物力学重建效果的影响。方法回顾性选取2014年1月至2019年10月重庆市中医骨科医院收治的桡骨颈骨折患儿105例,依据采取的固定方式将其分为研究组(采用闭合复位弹性髓内钉固定,n=60)、对照组(采用切开复位克氏针固定,n=45)。术后均随访1年,比较两组手术一般情况、肘关节功能恢复效果[Mayo肘关节功能评分(MEPS)]、Metaizeau复位优良率、末次随访时肘关节活动度、并发症发生率。结果研究组手术时间、住院时间、固定时间较对照组短,研究组术中出血量低于对照组,研究组透视次数较对照组多(P<0.05),两组术后倾斜角度比较差异无统计学意义(P>0.05);术后两组MEPS评分均增加,且研究组术后4周、8周、12周MEPS评分高于对照组(P<0.05);研究组术后Metaizeau复位优良率高于对照组(P<0.05);末次随访时,研究组患侧屈、伸、旋前、旋后与健侧比较差异无统计学意义(P>0.05),对照组患侧屈、伸、旋前活动度均小于健侧(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论与切开复位克氏针固定相比,闭合复位弹性髓内钉固定治疗桡骨颈骨折患儿疗效更好,可促进肘关节生物力学恢复,提高复位优良率,且不增加并发症风险,值得在临床推广实践。Objective To observe the effects of closed reduction with elastic intramedullary nail and open reduction with Kirschner wire fixations on the biomechanical reconstruction of elbow joints in children with radial neck fractures.Methods A total of 105 children with radial neck fractures admitted to Chongqing Traditional Chinese Orthopedic Hospital between January 2014 and October 2019 were retrospectively selected.They were divided into the study group(closed reduction with elastic intramedullary nail fixation,n=60)and the control group(open reduction with Kirschner wire fixation,n=45)according to the fixation method.All subjects were followed up for 1 year after surgery.The general situation of surgery,recovery effect of elbow joint function[Mayo elbow performance score(MEPS)],excellent and good rate of Metaizeau reduction,elbow mobility at the last follow-up and the incidence rate of complications were compared between the two groups.Results The operation time,hospital stay and fixation time of the study group were shorter than those of the control group.The intraoperative blood loss of the study group was less than that of the control group.The frequency of fluoroscopy in the study group was less than that in the control group(P<0.05).There was no significant difference in the tilt angle between the two groups after surgery(P>0.05).MEPS scores of both groups increased after surgery,and the MEPS scores of the study group at 4 weeks,8 weeks and 12 weeks after surgery were higher than those of the control group(P<0.05).The excellent and good rate of Metaizeau reduction in the study group was higher than that in the control group(P<0.05).At the last follow-up,there was no significant difference in flexion,extension,pronation or supination between the affected side and the healthy side of the study group(P>0.05).For the control group,flexion,extension and pronation on the affected side were smaller than the healthy side(P<0.05).There was no significant difference in the incidence rate of complications between the two

关 键 词：桡骨颈骨折 闭合复位弹性髓内钉固定 切开复位克氏针固定 生物力学 

分 类 号：R726.8[医药卫生—儿科]