克氏针“去锐性化”髓内弹性复位技术治疗GartlandⅢ型伸直桡偏型儿童肱骨髁上骨折  

A technique of"de‑sharpening"intramedullary elastic reduction with Kirschner wire for the treatment of Gartland type III posterolaterally‑displaced supracondylar humerus fracture in children

作　　者：林昱东 张思成[1] 周成 孟阁 袁悦 刘方[1] 孙军[1] Lin Yudong;Zhang Sicheng;Zhou Cheng;Meng Ge;Yuan Yue;Liu Fang;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》2023年第5期435-442,共8页Chinese Journal of Trauma

基　　金：国家自然科学基金(U19A2057);安徽省卫生健康科研项目(AHWJ2021b136,AHWJ2022b008)。

摘　　要：目的比较克氏针“去锐性化”髓内弹性复位技术和传统三维立体整复法治疗GartlandⅢ型伸直桡偏型儿童肱骨髁上骨折的疗效。方法采用回顾性队列研究分析2020年3月至2022年6月安徽省儿童医院收治的106例GartlandⅢ型伸直桡偏型肱骨髁上骨折患者的临床资料,其中男58例,女48例;年龄1~12岁[(8.7±2.3)岁]。50例采用克氏针“去锐性化”髓内弹性复位技术治疗(研究组),56例采用传统三维立体整复法治疗(对照组)。比较两组手术时间、术中透视次数、骨折愈合时间,以及术后3,6个月患侧与健侧Baumann角差异值、末次随访时肘关节功能Flynn评分和术后并发症情况。结果患者均获随访6~12个月[(8.5±1.2)个月]。研究组手术时间和术中透视次数为(32.9±3.7)min、(20.6±5.4)次,对照组分别为(45.6±10.1)min、(32.5±8.2)次(P均<0.01)。研究组骨折愈合时间为(33.0±5.1)d,对照组为(33.8±4.7)d(P>0.05)。术后3,6个月研究组患侧与健侧Baumann角差异值分别为(3.2±0.8)°和(2.3±0.6)°,对照组分别为(6.0±2.1)°和(5.8±1.3)°(P均<0.01)。末次随访时肘关节功能Flynn评分:研究组优44例,良5例,可1例,优良率为98.0%(49/50);对照组优47例,良5例,可4例,优良率为92.9%(52/56)(P>0.05)。两组患者均无骨髓炎、骨折愈合不良、骨筋膜间隔综合征、医源性血管神经损伤或骨化性肌炎等并发症。结论克氏针“去锐性化”髓内弹性复位技术和传统三维立体整复法治疗GartlandⅢ型伸直桡偏型儿童肱骨髁上骨折,均能恢复肘关节功能,且并发症发生率低,但前者无须反复手法复位,手术时间更短,透视次数更少,桡偏和旋转畸形纠正更好。Objective To compare the clinical effect of"de‑sharpening"intramedullary elastic reduction with Kirschner wire and traditional three‑dimensional manipulation for the treatment of Gartland type III posterolaterally‑displaced supracondylar humerus fracture in children.Methods A retrospective cohort analysis was made on 106 children with Gartland type III posterolaterally‑displaced supracondylar humerus fracture treated in Anhui Provincial Children′s Hospital from March 2020 to June 2022,including 58 males and 48 females;aged 1‑12 years[(8.7±2.3)years].The patients were assigned to"de‑sharpening"intramedullary elastic reduction with Kirschner wire(study group,n=50)and traditional three‑dimensional manipulation(control group,n=56).The operation time,frequency of intraoperative fluoroscopy,fracture healing time,difference of Baumann angle between the normal and injured side at postoperative 3 and 6 months,elbow function Flynn score at last follow‑up and complications were compared between the two groups.Results All children were followed up for 6‑12 months[(8.5±1.2)months].The operation time and frequency of intraoperative fluoroscopy were(32.9±3.7)minutes and(20.6±5.4)times in study group,significantly different from(45.6±10.1)minutes and(32.5±8.2)times in control group(all P<0.05).The fracture healing time was(33.0±5.1)days in study group,similar with(33.8±4.7)days in control group(P>0.05).At 3 and 6 months after operation,the difference of Baumann angle between the normal and injured side was(3.2±0.8)°and(2.3±0.6)°in study group compared to(6.0±2.1)°and(5.8±1.3)°in control group(all P<0.01).According to the elbow function Flynn score at the last follow‑up,the results were excellent in 44 children,good in 5 and fair in 1,with the excellent and good rate of 98.0%(49/50)in study group,and were excellent in 47 children,good in 5 and fair in 4,with the excellent and good rate of 92.9%(52/56)in control group(P>0.05).There were no following complications in both groups,such as osteomy

关 键 词：肱骨骨折 骨折闭合复位 儿童 

分 类 号：R726.8[医药卫生—儿科]