经尺骨鹰嘴操纵杆技术辅助闭合复位治疗儿童多方向不稳定肱骨髁上骨折  

Clinical observation of utilizing a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children

作　　者：韦宜山[1] 刘万林[1] 王国强[2] 郝强[2] 白锐[1] 李岱鹤[1] 赵振群[1] 王勇[1] 孙亮[1] 孙超[1] 娜木罕 杨德文 马国洋 Wei Yishan;Liu Wanlin;Wang GuoQiang;Hao Qiang;Bai Rui;Li Daihe;Zhao Zhenqun;Wang Yong;Sun Liang;Sun Chao;Na Muhan;Yang Dewen;Ma Guoyang(Department of Pediatric Orthopaedics,the Second Affiliated Hospital of the Inner Mongolia Medical University,Huhehot 010030,China;Department of Pediatric Orthopaedics,the Baotou Fourth Hospital,the Inner Mongolia,Baotou 014030,China)

机构地区：[1]内蒙古医科大学第二附属医院小儿骨科,呼和浩特010030 [2]内蒙古包头市第四医院小儿骨科,014030

出　　处：《中华骨科杂志》2020年第20期1397-1408,共12页Chinese Journal of Orthopaedics

基　　金：国家临床重点专科建设经费资助项目(财社[2010]305号)。

摘　　要：目的对比闭合复位经皮克氏针固定(closed reduction and percutaneous pinning,CRPP)和使用经尺骨鹰嘴操纵杆技术辅助闭合复位治疗儿童多方向不稳定肱骨髁上骨折的临床结果。方法收集2012年1月至2019年1月39例分别进行CRPP和经尺骨鹰嘴操纵杆技术辅助CRPP治疗的多方向不稳定肱骨髁上骨折患儿资料,其中男27例,女12例;年龄(6.68±2.52)岁(范围2.17~13.75岁)。23例(58.97%)单纯采用CRPP治疗(CRPP组);16例(41.03%)采用经尺骨鹰嘴操纵杆技术辅助下CRPP治疗(操纵杆组)。计量资料采用配对样本t检验、计数资料应用χ2检验和Fisher精确概率法比较两组间手术时间、透视次数、复位质量和术后并发症的差异,术后16周和末次随访时与健侧相比较,患侧Baumann角、提携角、侧位肱头角、肘关节功能和活动范围之间的差异。结果 39例随访时间(1.98±1.43)年;术后4~6周均获骨折临床愈合。CRPP组手术时间(48.59±15.75)min,透视次数(49.65±23.83)次,操纵杆组为(27.17±9.68)min和(24.25±5.92)次,差异有统计学意义(P<0.05)。所有患儿术后侧位肱头角均恢复正常。CRPP组术后16周患侧冠状面Baumann角77.70°±2.16°,健侧73.78°±4.04°,操纵杆组分别为73.06°±1.81°和72.81°±3.45°;末次随访时CRPP组患侧冠状面Baumann角77.13°±2.20°,健侧74.17°±4.17°,操纵杆组分别为72.69°±1.70°和73.38°±3.48°,操纵杆组冠状面复位质量明显优于CRPP组(P<0.05)。术后16周CRPP组Flynn标准肘关节功能优良率82.61%,肘关节屈曲134.13°±8.61°,肘关节伸直-3.48°±6.47°,操纵杆组分别为81.25%,132.19°±9.48°和-3.44°±4.37°;末次随访时,CRPP组Flynn标准肘关节功能优良率91.30%,肘关节屈曲140.14°±5.76°,肘关节伸直-0.65°±3.79°,操纵杆组分别为93.75%,141.88°±5.12°和-0.31°±3.86°,两组Flynn标准评定肘关节功能优良率和运动范围相似。结论使用经尺骨鹰嘴操纵杆技术辅助CRPP治疗儿童多方向不稳定�Objective Compared with closed reduction and percutaneous pinning(CRPP)treatment,evaluating the clinical observation of utilizing a transolecranon pin joystick technique combined with CRPP in the teatment of multidirectionally unstable supracondylar humeral fractures in children.Methods From thirty nine pediatric multidirectionally unstable supracondylar humeral fractures hospitalized between January 2012 and January 2019,twenty seven males(69.23%)and twelve females(30.77%)were included in the study,with a average age of 6.68±2.52 years(range,2.17-13.75 y),twenty three fractures(65.7%)were treated with CRPP(CRPP group)and the remaining Sixteen fractures(41.03%)were treated utilizing a transolecranon pin joystick technique combined with CRPP(joystick group).Both groups were followed over 16 weeks.The paired sample t test orχ2 test and Fisher's exact test were used to compare the surgical time,times of fluoroscopy,quality of reduction and neurological or vascular complications,Baumann angle,carrying angle,lateralcapitellohumeral angle,postoperative range of motion as well as function-al outcomeduringthe Sixteen weeks and the last follow-up appointment.Results All caseswere followed up for 1.98±1.43 years,and all fractures achieved clinical healing at 4 to 6 weeks postoperation.The surgical time and times of fluoroscopy were significantly shorter for patients in the joystick group(27.17±9.68 min,24.25±5.92 times)when compared with CRPP group(48.59±15.75 min,49.65±23.83 times,P<0.05).All cases showed restoration of the normal lateral capitellohumeral angle.Compared with Baumann angle of normal contralateral upper extremity during the sixteen weeks and the last follow-up appointment,the quality of reduction on the anteroposterior radiographic view was significantly better for patients in the joystick group than that of CRPP group(P<0.05).The Baumann angle of the affected upper extremity was 77.70°±2.16°,and that of the normal contralateral upper extremity was 73.78°±4.04°in the CRPP group,joystick group w

关 键 词：肱骨骨折 骨折 闭合性 内固定器 评价研究 治疗结果 

分 类 号：R726.8[医药卫生—儿科]