儿童肱骨髁上骨折闭合复位两种克氏针固定方法效果观察  

Observation on the effect of two Kirschner wire fixation methods for closed reduction of supracondylar humerus fracture in children

作　　者：吴敏[1] 夏群英 易申德 蔡军[1] 杜香平 熊斌[1] 吴欣乐 WU Min;XIA Qunying;YI Shende;CAI Jun;DU Xiangping;XIONG Bin;WU Xinle(Department of Pediatric Orthopedics,the Affiliated Children′s Hospital of Nanchang University,Jiangxi Provincial Children′s Hospital,Nanchang330006,China)

机构地区：[1]南昌大学附属儿童医院江西省儿童医院小儿骨科,江西南昌330006

出　　处：《中国现代医生》2022年第4期75-78,82,共5页China Modern Doctor

基　　金：江西省卫生健康委科技计划项目(20203700)。

摘　　要：目的观察内外交叉与单纯外侧交叉两种克氏针固定方法治疗儿童肱骨髁上骨折的临床效果。方法回顾性分析自2016年1月至2019年12月在江西省儿童医院小儿骨科诊断肱骨髁上骨折并行手术闭合复位+克氏针固定的患儿共218例。根据患儿采用的克氏针固定方法分为内外交叉组(桡侧两根+尺侧一根)和单纯外侧组(单纯桡侧三根)。观察两组术后有无骨感染、Volkmann挛缩、肘内翻、针尾激惹及神经损伤等,并对结果进行统计学分析。结果所有病例无骨感染、Volkmann挛缩及肘内翻畸形等发生。内外交叉组术后发生针尾激惹内外交叉组14例,单纯外侧组6例,组间比较差异无统计学意义(P>0.05)。内外交叉组出现2例(1.32%)医源性尺神经损伤,单纯外侧组未出现,组间比较差异有统计学意义(P<0.05)。随访时骨折全部愈合,末次随访肘关节功能评价两组优良率比较,差异无统计学意义(P>0.05)。结论内外交叉克氏针与单纯外侧交叉克氏针治疗小儿肱骨髁上骨折稳定可靠,临床治疗效果无显著差异,但内外交叉克氏针固定有损伤尺神经的风险。Objective To observe the clinical effects of two Kirschner wire fixation methods(i.e.internal and external cross and simple lateral cross)in the treatment of supracondylar humerus fracture in children.Methods A total of 218 children who were diagnosed with supracondylar humerus fracture in the department of orthopedics,Jiangxi Provincial Children′s Hospital from January 2016 to December 2019 and received surgical closed reduction combined with Kirschner wire fixation were retrospectively analyzed.According to the Kirschner wire fixation method used for patients,they were divided into the internal and external cross group(two wires on the radial side+one wire on the ulnar side)and the simple lateral cross group(three wires on the radial side only).The two groups were observed for bone infection,Volkmann contracture,cubitus varus,Kirschner wire tail irritation and nerve injury after surgery,and the results were statistically analyzed.Results There was no bone infection,Volkmann contracture,and cubitus varus deformity in all cases.Kirschner wire tail irritation occurred in 14 cases in the internal and external cross group and 6 cases in the simple lateral cross group,without statistically significant difference between the two groups(P>0.05).There were 2 cases(1.32%)of iatrogenic ulnar nerve injury in the internal and external cross group,but no case in the simple lateral cross group,with statistically significant difference between the two groups(P<0.05).All fractures healed at follow-up,and there was no statistically significant difference in terms of the excellent rate in elbow joint function evaluation between the two groups at the last follow-up(P>0.05).Conclusion The methods of Internally and externally crossed Kirschner wires and simple laterally crossed Kirschner wires are stable and reliable in the treatment of supracondylar humerus fractures in children,and there is no statistically significant difference in terms of clinical treatment effect.However,the method of internally and externally crossed Kirsch

关 键 词：儿童 肱骨髁上骨折 克氏针 闭合复位 

分 类 号：R269.8[医药卫生—中西医结合]