克氏针重建骨膜铰链联合“擀面杖”技术治疗儿童屈曲桡偏型肱骨髁上骨折  

Kirschner wire reconstruction of periosteal hinge combined with"rolling pin"technique in the treatment of flexion-radial deviated supracondylar fracture of the humerus in children

作　　者：马海龙 管之也 孙锡玮 褚祥军 李阳[1] 袁亮[1] 孙军[1] Ma Hailong;Guan Zhiye;Sun Xiwei;Chu Xiangjun;Li Yang;Yuan Liang;Sun Jun(Department of Orthopedics,Fifth Clinical Medical College of Anhui Medical University,Anhui Medical University Children′s Medical Center,Anhui Provincial Children′s Hospital,Hefei 230051,China)

机构地区：[1]安徽医科大学第五临床医学院,安徽医科大学儿童医学中心,安徽省儿童医院骨科,合肥230051

出　　处：《中华创伤杂志》2022年第6期545-550,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金(67976008)。

摘　　要：目的比较克氏针重建骨膜铰链联合"擀面杖"技术协助闭合复位经皮克氏针内固定治疗和闭合复位经皮克氏针内固定治疗儿童屈曲桡偏型肱骨髁上骨折的临床疗效。方法采用回顾性队列研究分析2017年1月至2021年12月安徽省儿童医院收治的85例屈曲桡偏型肱骨髁上骨折患者临床资料,其中男53例,女32例;年龄4~14岁[(7.4±2.7)岁]。49例采用克氏针重建骨膜铰链联合"擀面杖"技术协助闭合复位经皮克氏针内固定治疗(研究组),36例采用闭合复位经皮克氏针内固定治疗(对照组)。比较两组手术时间、术中透视次数、闭合复位失败改行切开复位患者比例(下文统称切开率)、骨折愈合时间及末次随访时肘关节功能Flynn评分。观察两组术后2个月并发症情况(如感染及克氏针针尾激惹等)。结果患者均获随访2~12个月[(6.2±2.2)个月]。对照组手术时间、术中透视次数分别为(62.4±21.4)min、(34.8±7.1)次,明显长于或多于研究组的(31.2±14.1)min、(22.5±5.1)次(P<0.05或0.01)。对照组切开率为17%,而研究组为0(P<0.01)。对照组和研究组骨折愈合时间分别为(4.5±0.8)周和(4.6±0.6)周(P>0.05)。按Flynn评分,末次随访时对照组肘关节优良率为89%,其中优26例,良6例,可4例,差0例;研究组肘关节优良率为94%,其中优41例,良5例,可3例,差0例(P>0.05)。术后2个月两组患者均未发生感染、克氏针针尾激惹。结论克氏针重建骨膜铰链联合"擀面杖"技术协助闭合复位经皮克氏针内固定治疗与闭合复位经皮克氏针内固定治疗儿童屈曲桡偏型肱骨髁上骨折效果相似,但前者可缩短手术时间,减少术中透视次数,降低切开率。Objective To investigate the clinical efficacy of Kirschner wire reconstruction of periosteal hinge combined with"rolling pin"technique assisting closed reduction and percutaneous Kirschner wire fixation versus closed reduction and percutaneous Kirschner wire fixation in the treatment of flexion-radial deviated supracondylar fracture of the humerus in children.Methods A retrospective cohort study was used to analyze the clinical data of 85 patients with flexion-radial deviated supracondylar fracture of the humerus treated in Anhui Provincial Children′s Hospital from January 2017 to December 2021,including 53 males and 32 females;aged 4-14 years[(7.4±2.7)years].There were 49 patients treated by Kirschner wire reconstruction of periosteal hinge combined with"rolling pin"technique assisting closed reduction and percutaneous Kirschner wire fixation(study group)and 36 patients by closed reduction and percutaneous Kirschner wire fixation(control group).The operation time,number of intraoperative fluoroscopy,rate of incision after failure of closed reduction(hereinafter referred to as rate of incision),fracture healing time,and elbow joint function by Flynn score at the last follow-up were compared between the two groups.Complications were observed at 2 months after operation,such as infection and irritation of the Kirschner pin tail.Results All patients were followed up for 2-12 months[(6.2±2.2)months].The operation time and number of intraoperative fluoroscopy was(62.4±21.4)minutes and(34.8±7.1)times in control group,significantly longer or more than(31.2±14.1)minutes and(22.5±5.1)times in study group(P<0.05 or 0.01).The incision rate was 17%in control group,but was 0 in study group(P<0.01).The fracture healing time had no significant difference between control group and study group[(4.5±0.8)weeks vs.(4.6±0.6)weeks](P>0.05).According to Flynn score at the last follow-up,the excellent and good rate of elbow function was 89%in control group(excellent in 26 patients,good in 6,fair in 4,poor in none),not signifi

关 键 词：儿童 肱骨骨折 骨折固定术 内 

分 类 号：R726.8[医药卫生—儿科]