儿童屈曲型肱骨髁上骨折闭合复位失败的危险因素分析  

Risk factors for failure in closed reduction of flexed supracondylar humerus fractures in children

作　　者：杨小刚 贾国强 孟连 林昱东 孟阁 孙军 Yang Xiaogang;Jia Guoqiang;Meng Lian;Lin Yudong;Meng Ge;Sun Jun(Department of Orthopaedics,Children's Hospital of Jiangxi Province,Nanchang 330013,China;Children's Hospital of Fudan University Anhui Hospital,Hefei 230001,China)

机构地区：[1]江西省儿童医院骨科,南昌330013 [2]复旦大学附属儿科医院安徽医院骨科,合肥230001

出　　处：《中华创伤骨科杂志》2023年第5期401-406,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(61976008)。

摘　　要：目的探讨儿童屈曲WilkinsⅢ型肱骨髁上骨折闭合复位失败的相关危险因素。方法回顾性分析2015年1月至2021年12月江西省儿童医院骨科和复旦大学附属儿科医院安徽医院骨科收治的171例WilkinsⅢ型屈曲型肱骨髁上骨折患儿的病例资料。根据患儿闭合复位是否失败分为闭合复位失败组(35例)和闭合复位成功组(136例)。将骨折高低位置、年龄、体重指数、尺桡偏移位方向、远端骨折块是否明显轴向旋转、是否合并尺神经损伤、受伤至手术时间等因素列为危险因素,通过单因素分析和多因素logistic回归分析,明确屈曲型肱骨髁上骨折闭合复位失败的独立危险因素及发生风险。结果171例患儿年龄为(7.8±2.6)岁;151例桡偏,20例尺偏;高位型120例,低位型51例;合并尺神经损伤20例,远端骨折块明显旋转115例。单因素分析结果显示:闭合复位失败组和闭合复位成功组患儿在年龄、远端骨折块明显旋转、尺神经损伤方面差异有统计学意义(P<0.05),骨折高低位置、体重指数、尺桡偏移位方向、受伤至手术时间方面差异无统计学意义(P>0.05)。多因素logistic回归分析显示远端骨折块明显旋转(OR=3.287,95%CI:1.136~9.513,P=0.028)和尺神经损伤(OR=6.439,95%CI:2.262~18.327,P=0.001)为闭合复位失败的危险因素。结论儿童屈曲WilkinsⅢ型肱骨髁上骨折伴随远端骨折块明显旋转和(或)尺神经损伤容易导致闭合复位失败,临床治疗此类骨折时要更加重视。Objective To identify the risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins typeⅢin children.Methods The data of 171 children were retrospectively analyzed who had been treated for flexed supracondylar humerus fractures of Wilkins typeⅢfrom January 2013 to December 2021 at Department of Orthopaedics,Children's Hospital of Jiangxi Province and Children's Hospital of Fudan University Anhui Hospital.They were divided into a reduction failure group(35 cases)and a reduction success group(136 cases).Factors such as fracture height,age,body mass index,ulnar-radial offset direction,obvious axial rotation of the distal fracture fragment,combined ulnar nerve injury,and time from injury to operation were listed as risk factors.The independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures were identified by univariate analysis of variance and multi-variate logistic regression analysis.Results The average age of 171 children was(7.8±2.6)years.There were 151 cases of radial deviation and 20 cases of ulnar deviation,120 high type fractures and 51 low type fractures,and 20 cases of combined ulnar nerve injury and 115 cases of obvious rotation of the distal fracture fragment.The one-way ANOVA showed statistically significant differences between the reduction failure group and the reduction success group in terms of age,obvious rotation of the distal fracture fragment,and ulnar nerve injury(P<0.05),but no significant differences in fracture height,body mass index,ulnar-radial offset direction,or time from injury to operation(P>0.05).Multivariate logistic regression analysis showed that obvious rotation of the distal fracture fragment(OR=3.287,95%CI:1.136 to 9.513,P=0.028)and combined ulnar nerve injury(OR=6.439,95%CI:2.262 to 18.327,P=0.001)were risk factors for failure in closed reduction.Conclusion As obvious rotation of the distal fracture fragment and combined ulnar nerve injury may be independent risk factors for failure in closed re

关 键 词：儿童 肱骨 危险因素 肱骨髁上骨折 闭合复位 

分 类 号：R726.8[医药卫生—儿科]