经尺骨鹰嘴操纵杆辅助闭合复位技术治疗儿童Gartland Ⅳ型肱骨髁上骨折手术潜在风险因素的对比研究  

A comparative study on potential risks of surgery in the treatment of Gartland type Ⅵ supracondylar humeral fracture with a transolecranon pin joystick in Children

作　　者：韦宜山[1] 娜木罕 刁艳龙 白锐[1] 李岱鹤[1] 赵振群[1] 王勇[1] 孙亮[1] 孙超[1] 刘万林[1] WEI Yi-shan;NA Mu-han;DIAO Yan-long;BAI Rui;LI Dai-he;ZHAO Zhen-qun;WANG Yong;SUN Liang;SUN Chao;LIU Wan-lin(Department of Pediatric Orthopaedics,The Second Affiliated Hospital of Inner Mongolia Medical University,Huhehot,Inner Mongolia,010030,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]杭锦旗人民医院骨科,鄂尔多斯017400

出　　处：《中国骨与关节杂志》2021年第3期181-191,共11页Chinese Journal of Bone and Joint

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：目的与闭合复位经皮克氏针固定 (closed reduction and percutaneous pinning,CRPP)相比,探讨经尺骨鹰嘴操纵杆辅助闭合复位治疗Gartland Ⅳ型肱骨髁上骨折患儿手术潜在风险因素并比较两种治疗方式的临床效果。方法回顾性分析2012年1月至2019年1月,手术治疗39例Gartland Ⅳ型肱骨髁上骨折患儿的临床资料。其中,男27例 (69.23%),女12例(30.77%),平均年龄(6.68±2.52) (2~13) 岁。23 例(58.97%)Gartland Ⅳ型骨折单纯采用 CRPP治疗(CRPP组);16例(41.03%) 实施经尺骨鹰嘴操纵杆技术辅助闭合复位技术治疗 (操纵杆组)。计量资料采用配对样本t检验、计数资料采用false检验和 Fisher 确切概率法比较两组手术时间、透视次数、术中冠状面Baumann角和矢状面侧位肱头角之间的差异;末次随访时与正常对侧比较两组复位质量、肘关节功能以及并发症之间的差异。结果所有患儿平均随访 (1.98±1.43) 年,术后4~6周均获骨折愈合。CRPP组平均手术时间 (48.59±15.75)min,透视次数(49.65±23.83) 次,操纵杆组分别为(27.17±9.68)min 和(24.25±5.92) 次,与 CRPP组比较,操纵杆组平均手术时间和透视次数缩短 21 min和下降 25 次,两组相比差异均有统计学意义(P<0.05)。术中复位固定后 CRPP组Baumann角(78.54±0.55) °,操纵杆组为(73.21±1.03) °,两组相比差异有统计学意义(P<0.05),操纵杆组术中冠状面复位质量优于 CRPP组。所有患儿矢状面侧位肱头角均恢复正常。末次随访时,CRPP组患侧Baumann角(77.13±2.20) °,正常对侧 (74.17±4.17) °,操纵杆组分别为 (72.69±1.70) °和 (73.38±3.48) °,操纵杆组最终冠状面复位质量优于 CRPP组 (P<0.05);两组Flynn标准评定肘关节功能优良率和运动范围相似。两组均没有切开复位和术后即刻并发症发生。结论使用经尺骨鹰嘴操纵杆辅助闭合复位技术治疗患儿Gartland Ⅳ型肱骨髁上骨折可以缩短手术时间、减少放射暴露、提高复位质量Objective To evaluate potential risks of surgery and clinical effects of transolecranon pin joystick in the teatment of Gartland type Ⅳ supracondylar humeral fractures in children compared with closed reduction and percutaneous pinning (CRPP).Methods Clinical and radiological data of 39 patients with Gartland type Ⅳ supracondylar humeral fracture were retrospectively analyzed between January 2012 and January 2019.There were27 males (69.23%) and 12 females (30.77%) with an average age of (6.68±2.52) years (range:2.17-13.75 years).Twenty-three patients (58.97%) were treated with CRPP (CRPP group),and the remaining sixteen patients (41.03%) were treated with CRPP and a transolecranon pin joystick (joystick group).The paired sample t test,χ2 falsetest and Fisher’s exact test were used to compare the surgery time,fluoroscopy frequency,Baumann angle and lateral capitellohumeral angle intraoperatively.Quality of reduction,postoperative range of motion,functions and complications were compared between the two group at the final follow-up.Results All cases were followed up for (1.98±1.43) years,and all fractures achieved clinical healing at 4 to 6 weeks post-operation.The surgery time and fluoroscopy frequency were significantly shorter / lower 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]by a mean of 21 minutes and 25 times (P < 0.05).Baumann angle of the joystick group (73.21±1.03) ° was significantly lower than that of CRPP group (78.54±0.55) ° intraoperatively (P < 0.05).The quality of coronal plane reduction was higher in the joystick group intraoperatively.All cases showed restoration of the normal lateral capitellohumeral angle in the lateral view.The Baumann angles of the affected upper extremity and normal contralateral upper extremity in the CRPP group and joystick group were (77.13±2.20) °,(74.17±4.17) °,(72.69±1.70) °,(73.38±3.48) °,respectively,at the final follow-up.The quality of coronal plane reduction

关 键 词：肱骨骨折 骨折闭合复位 操纵杆技术 

分 类 号：R726.8[医药卫生—儿科] R683.4[医药卫生—临床医学]