手法闭合复位配合两种克氏针固定方式治疗GartlandⅡ型和Ⅲ型儿童肱骨髁上骨折疗效比较  

Comparison of clinical effect of two different Kirschner wire fixations after closed reduction on supracondylar fracture of humerus in children with GartlandⅡandⅢ

作　　者：黄晋[1] 罗鹏飞 刘春娥 HUANG Jin;LUO Peng-fei;LIU Chun-e(Gansu Univesity of Chinese Medicine,Lanzhou730000,Gansu,China)

机构地区：[1]甘肃省中医院,甘肃兰州730050 [2]甘肃中医药大学,甘肃兰州730000

出　　处：《中国骨伤》2020年第10期895-902,共8页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较手法闭合复位后采用克氏针桡侧扇形固定和尺桡双侧交叉固定治疗儿童肱骨髁上骨折的临床疗效。方法:对2017年3月至2018年12月采用手法闭合复位克氏针固定治疗的60例肱骨髁上骨折患儿的临床资料进行回顾性分析,按穿针方式不同分为两组。桡侧3枚针扇形固定组(A组)30例,男19例,女11例,年龄2~10(5.00±2.10)岁;Gartland分型,Ⅱ型21例,Ⅲ型9例。尺桡双侧3枚针交叉固定组(B组)30例,男22例,女8例;年龄1~9(5.13±2.08)岁;Gartland分型,Ⅱ型19例,Ⅲ型11例。观察并比较两组患儿骨折愈合时间、术后并发症、术后肘关节屈伸活动度和前臂旋转活动度恢复情况,术后肘关节提携角及其角度丢失情况,末次随访时采用Mayo肘关节功能评分进行疗效评价。结果:两组患儿均获得随访,但两组患儿随访时间、骨折愈合时间比较,差异无统计学意义(P>0.05)。A组术后1例发生医源性尺神经损伤,B组9例,差异有统计学意义(P<0.01);A组2例发生轻度骨折再移位,B组1例,差异无统计学意义(P>0.05)。无肘内翻畸形、针道感染、骨筋膜室综合征及骨化性肌炎发生。术后3个月两组患儿肘关节屈伸活动度、前臂旋转活动度比较,差异无统计学意义(P>0.05);术后3、6个月时两组肘关节提携角及其丢失角度比较,差异无统计学意义(P>0.05);末次随访Mayo肘关节功能评分及疗效评价比较,差异无统计学意义(P>0.05)。结论:骨折早期采用手法闭合复位克氏针固定具有创伤小,易复位,固定稳定,可以早期功能锻炼的优势。桡侧3枚针扇形固定造成医源性尺神经损伤的风险较尺桡双侧3枚针交叉固定更小。Objective:To compare clinical effect of Kirschner wire radial sector fixation and bilateral ulnar radial cross fixation in treating supracondylar fracture of humerus in children after closed reduction.Methods:From March 2017 to December 2018,60 children with supracondylar fracture of humerus treated with closed reduction and Kirschner wire fixation were analyzed retrospectively,and divided into two groups according to different needling methods.Thirty patients in radial three needles fan fixation group(group A),including 19 males and 11 females,aged from 2 to 10 years old with an average of(5.00±2.10)years old,21 patients were typeⅡand 9 patients were typeⅢaccording to Gartland classification.Thirty patients in cross fixation with 3 needles on both ulnar and radial side group(group B),including 22 males and 8 females,aged from 1 to 9 years old with an average of(5.13±2.08)years old,19 patients were typeⅡand 11 patients were typeⅢ.Healing time of fracture,postoperative complications,elbow flexion and extension activity,forearm rotation activity recovery,elbow carrying angle and angle loss after operation between two groups were observed and compared.Mayo Elbow function score at the final following-up was used to evaluate clinical efficacy.Results:All patients were followed up,while there were no significant difference in follow-up time and fracture healing time between two groups(P>0.05);there was 1 patient occurred iatrogenic ulnar nerve injury in group A,9 patients in group B,and there was difference between two groups(P<0.01);2 patients in group A occurred mild displacement and 1 patient in group B,while no significant difference between two groups(P>0.05).No cubitus varus deformity,needle infection,osteofascial compartment syndrome and myositis ossificans occurred.There was no significant difference in elbow flexion,extension activity,and forearm rotation activity between two groups at 3 months after operation(P>0.05);there was no significant difference in elbow carrying angle and its loss angle betw

关 键 词：肱骨骨折 儿童 骨折闭合复位 骨折固定术 内 

分 类 号：R683.41[医药卫生—骨科学]