闭合复位经皮克氏针固定治疗Ⅳ型肱骨髁上骨折的疗效研究  

Curative efficacy analysis of treating typeⅣpaediatric supracondylar humeral fractures through closed reduction and percutaneous pinning

作　　者：俞文涛 张福勇[1] 方建峰[1] 刘尧[1] 俞皋 王晓东[1] Yu Wentao;Zhang Fuyong;Fang Jianfeng;Liu Yao;Yu Gao;Wang Xiaodong(Department of Orthopaedics,Affiliated Children's Hospital,Soochow University,Suzhou 215025,China)

机构地区：[1]苏州大学附属儿童医院骨科,苏州215025

出　　处：《中华小儿外科杂志》2022年第6期544-549,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨采用三人法闭合复位及经皮克氏针固定治疗儿童Ⅳ型肱骨髁上骨折的疗效及意义。方法收集2016年1月至2019年11月期间在苏州大学附属儿童医院接受手术治疗的145例Ⅲ型或Ⅳ型肱骨髁上骨折的患儿资料。按骨折分型对患儿进行分组,将26例Ⅳ型肱骨髁上骨折患儿作为A组,其中男19例,女7例,平均年龄为5.5岁,受伤侧为左侧12例,右侧14例。将119例Ⅲ型肱骨髁上骨折患儿作为B组,其中男84例,女35例,平均年龄为5.4岁,受伤侧为左侧73例,右侧46例。收集患儿年龄、性别、骨折时间、手术时间及克氏针固定方式等;观察患儿术后针道感染、骨折愈合、神经损伤恢复、术后鲍曼角、提携角丢失和肘关节活动度等情况;术后肘关节的功能恢复情况评估采用Flynn肘关节功能评分标准。结果所有患儿术后均未出现肘内翻、骨不连、骨化性肌炎或Volkmann缺血性挛缩,术后提携角和肘关节活动度依据Flynn评分优良率均达到96%。A、B两组患儿在年龄、性别、受伤侧别以及骨折时间方面的差异均无统计学意义。A组患儿手术时间较B组长,(36.3±13.8)min比(31.3±13.8)min,差异具有统计学意义(P=0.032),且A组手术使用第三枚甚至第四枚克氏针的概率较B组更高,46.2%(12/26)比27.7%(33/119),差异具有统计学意义(P=0.01)。A组患儿平均骨折愈合时间为4.6周,B组患儿平均骨折愈合时间为4.4周,两组患儿的骨折愈合时间之间的差异无统计学意义(P=0.105),针道感染率、肘关节活动度、鲍曼角、提携角丢失及肱骨前缘线延长线是否通过肱骨小头等在两组之间的差异均无统计学意义(P>0.05)。结论闭合复位经皮克氏针固定用于治疗儿童Ⅳ型肱骨髁上骨折可以获得与同法治疗Ⅲ型肱骨髁上骨折类似的较满意的疗效,Ⅳ型肱骨髁上骨折手术难度更大,需要更多的克氏针进行固定。Objective To explore the efficacy of closed reduction using"three-men method"and percutaneous pinning for typeⅣpediatric supracondylar humeral fractures.Methods Clinical data were retrospectively reviewed for 145 children with typeⅢ/Ⅳsupracondylar humeral fractures undergoing operations from January 2016 to November 2019.They were divided into two groups according to the fracture classification.Twenty-six children with typeⅣsupracondylar humeral fractures were selected as group A,including 19 boys and 7 girls with an average age of 5.5 years.Involved side was left(n=12)and right(n=14).And 119 children with typeⅢsupracondylar humeral fractures were assigned into group B,including 84 boys and 35 girls with a mean age of 5.4 years.Involved side was left(n=73)and right(n=46).Age,gender,fracture time,operative duration and Kirschner wire fixation method were recorded along with postoperative needle-path infection,fracture healing,nerve injury recovery,postoperative Bowman angle,loss of carrying angle and elbow range of motion.Postoperative functional recovery was assessed by the Flynn scoring criteria of elbow joint function.Results None had any postoperative onset of cubitus varus,nonunion,myositis ossificans or Volkmann ischemic contracture.The excellent/good rate of postoperative carrying angle and elbow range of motion according to Flynn score was 96%.There were no significant inter-group differences in age,gender,sideness of injury or fracture time.Operative duration in group A was longer than that in group B[(36.3±13.8)vs.(31.3±13.8)min]and the difference had statistical significance(P=0.032).The probability of using the third/fourth Kirschner wire was higher in group A than that in group B[46.2%(12/26)vs.27.7%(33/119)]and the difference had statistical significance(P=0.01).The average fracture healing time was 4.6 weeks in group A and 4.4 weeks in group B.No significant inter-group difference existed in fracture healing time(P=0.105).There were no significant inter-group differences in pin tract inf

关 键 词：肱骨骨折 闭合复位经皮克氏针内固定 儿童 

分 类 号：R687.3[医药卫生—骨科学]