儿童肱骨髁上骨折术后残留旋转畸形对术后疗效的影响分析  

Acceptable residual rotational deformity after supracondylar fracture of the humerus in children

作　　者：陈晋宸 吴新武 欧阳智斌 林然 陈顺有 Chen Jinchen;Wu Xinwu;Ouyang Zhibin;Lin Ran;Chen Shunyou(Department of Pediatric Orthopaedics,The Second Hospital of Fuzhou(The Second Fuzhou Hospital Affiliated to Xiamen University,The Third College of Clinical Medicine,Fujian Medical University),Clinical Research Center of Emergency and Rehabilitation in Orthopaedics&Traumatology in Fujian Province,Fuzhou Trauma Medical Center,Fuzhou 350007,China)

机构地区：[1]福州市第二医院(厦门大学附属福州第二医院、福建医科大学第三临床医学院)小儿骨科,福建省创伤骨科急救与康复临床医学研究中心,福州市创伤医学中心,福州350007

出　　处：《中华创伤骨科杂志》2023年第2期124-129,共6页Chinese Journal of Orthopaedic Trauma

基　　金：福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014);福建省临床重点专科(20220104)。

摘　　要：目的探讨儿童肱骨髁上骨折术后残留旋转畸形对术后疗效的影响。方法回顾性分析2020年1月至2021年12月福州市第二医院小儿骨科收治的453例GartlandⅢ型伸直型肱骨髁上骨折患者资料,所有患者均行闭合复位克氏针固定术。根据复位情况分为2组:残留旋转畸形组(A组)69例,男44例,女25例;年龄(6.3±2.9)岁;术中透视正位X线片上Baumann角维持在65°~80°,侧位X线片上肱骨前缘线通过肱骨小头前1/3,残留部分旋转畸形,但提携角正常(4°~23°)。解剖复位组(B组)384例,男242例,女142例;年龄(5.9±2.7)岁;术中透视正、侧位X线片示骨折端解剖复位。记录并比较两组患者术中透视次数、手术时间、术中提携角、术后6个月提携角和术后6个月肘关节Flynn评分。结果两组患者性别、年龄、侧别、克氏针固定时间比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获(6.3±2.9)个月随访。A组患者术中透视中位次数[6(4,6)次]少于B组[8(6,8)次],手术时间中位数[20(20,25)min]少于B组[30(25,30)min],差异均有统计学意义(P<0.05)。A组患者术中、术后6个月提携角分别为19.7°±2.7°、17.4°±2.7°,B组患者分别为20.2°±2.8°、17.6°±2.7°,两组间比较差异均无统计学意义(P>0.05)。术后6个月肘关节Flynn评分结果显示:A组优28例,良30例,中9例,差2例,优良率84.1%(58/69);B组优241例,良104例,中34例,差5例,优良率89.8%(345/384),两组间比较差异无统计学意义(P>0.05)。两组患儿在术后6个月随访时均未出现肘内翻畸形、骨折延迟愈合、骨折不愈合、骨筋膜室综合征、医源性尺神经损伤。结论儿童肱骨髁上骨折可以接受一定程度的旋转成角畸形,对术后疗效无显著影响,并且可减少术中透射次数,缩短手术时间。Objective To explore the effects of residual rotational deformity after supracondylar fractures of the humerus on the surgical efficacy in children.Methods From January 2020 to December 2021,453 patients with Gardland typeⅢsupracondylar humeral fracture were treated with closed reduction and percutaneous pinning at Department of Pediatric Orthopedics,The Second Hospital of Fuzhou.They were assigned into 2 groups according to the quality of reduction.In the group of residual rotational deformity of 69 cases(group A),there were 44 boys and 25 girls,with an age of(6.3±2.9)years.The Baumann angle was maintained at 65°to 80°on the anteroposterior view of intraoperative fluoroscopy and the anterior humeral line passed through the anterior 1/3 of the capitellum on the lateral view with a normal carrying angle(from 4°to 23°).In the anatomical reduction group of 384 patients(group B),there were 242 boys and 142 girls,with an age of(5.9±2.7)years.The anteroposterior view and the lateral view of intraoperative fluoroscopy showed anatomical reduction of the fracture ends.The fluoroscopy frequency,operation time,intraoperative carrying angle,the carrying angle at 6 months after operation and the Flynn score at 6 months after operation were recorded and compared between the 2 groups.Results There was no significant difference in gender,age,side or fixation time between the 2 groups before operation,showing they were comparable(P>0.05).All patients were followed up for(6.3±2.9)months after operation.The median intraoperative fluoroscopy frequency was 6(4,6)times in group A,significantly lower than that in group B[8(6,8)],and the median operation time was 20(20,25)min in group A,significantly shorter than that in group B[30(25,30)min](P<0.05).There was no significant difference between group A and group B in the intraoperative rying angle(19.7°±2.7°versus 20.2°±2.8°)or in the carrying angle at 6 months after operation(17.4°±2.7°versus 17.6°±2.7°)(P>0.05).By the Flynn scoring for the elbow joint at 6 months a

关 键 词：肘关节 肱骨骨折 骨折固定术 内 儿童 

分 类 号：R726.8[医药卫生—儿科]