肘关节镜辅助闭合复位治疗儿童Jakob Ⅱ型肱骨外髁骨折的早期疗效分析  

Early efficacy analysis of elbow arthroscopy assisted closed reduction in the treatment of Jakob type Ⅱ lateral condylar fracture of humerus in children

作　　者：俞颖豪 王军[1] 林伟枫 Yu Yinghao;Wang Jun;Lin Weifeng(Department of Pediatric Orthopedics,Wuxi 9th People's Hospital Afiliated to Suzhou University,Wuxi 214000,China)

机构地区：[1]苏州大学附属无锡九院小儿骨科,无锡214000

出　　处：《中华手外科杂志》2023年第3期218-222,共5页Chinese Journal of Hand Surgery

摘　　要：目的探究肘关节镜辅助闭合复位经皮克氏针固定治疗儿童JakobⅡ型肱骨外髁骨折的早期临床效果.方法我科自2020年3月至2022年4月收治JakobⅡ型肱骨外髁骨折患儿35例,其中14例接受肘关节镜辅助闭合复位经皮克氏针固定(关节镜组),21例接受切开复位经皮克氏针固定(切开组).比较两组手术时间与术中透视次数;术后随访两组患儿骨折愈合时间、手术瘢痕长度及并发症发生情况.术后6个月与末次随访时评估两组肘关节Dhillon功能评分,测量并比较患侧Baumann角.结果35例患儿术后随访时间为6~18个月.随访期内两组患儿骨折均愈合,无肘关节感染、畸形等严重并发症发生.切开组1例发生手术切口愈合不良,并发症发生率为4.76%(1例/21例).两组手术时间、术中透视次数、骨折愈合时间和末次随访Baumann角比较,差异均无统计学意义(P>0.05).关节镜组手术瘢痕长度为(7.4±1.6)mm,明显小于切开组(31.9±4.9)mm(P<0.001).术后6个月随访肘关节Dhillon功能评分:关节镜组优11例,良3例;切开组优9例,良11例,可1例;关节镜组优于切开组(P<0.05).末次随访肘关节Dhillon功能评分:关节镜组优13例,良1例;切开组优16例,良5例;两组差异无统计学意义(P>0.05).结论应用肘关节镜辅助闭合复位治疗儿童JakobⅡ型肱骨外髁骨折是安全且有效的治疗方法.与切开复位相比,该方法具有微创、可视、精准的治疗优势,术后早期即可获得良好且稳定的功能康复.Objective To investigate the early clinical efficacy of elbow arthroscopy-assisted closed reduction and percutaneous K-wire fixation in the treatment of Jakob type Ⅱ lateral condylar fracture of humerus in children.Methods From March 2020 to April 2022,35 children with Jakob type Ⅱ lateral condylar fracture of humerus were reviewed.Among them,14 cases were performed elbow arthroscopy-assisted closed reduction and percutaneous K-wire fixation(arthroscope group),and 21 cases were performed open reduction and percutaneous K-wire fixation(incision group).The surgical time and intraoperative fluoroscopy frequency between the two groups were compared.The fracture healing time,surgical scar length,and incidence of complications in both groups of children after surgery were followed up.The Dhillon score of elbow in two groups was evaluated at 6 months after operation and at the last follow-up.Meanwhile,Baumann angle was measured and compared.Results The postoperative follow-up time of 35 patients was 6 to 18 months.During the followup period,the fractures of both groups achieved healing without serious complications such as elbow joint infection or deformity.One case in the incision group experienced poor healing of the surgical incision,with a complication rate of 4.76%(1 case/21 cases).There was no statistically significant difference between the two groups in terms of surgical time,intraoperative fluoroscopy frequency,fracture healing time,and Baumann angle at the last follow-up(P>0.05).The surgical scar length in the arthroscope group was(7.4±1.6)mm,significantly smaller than that in the incision group(31.9±4.9)mm(P<0.001).After 6 months of follow-up,the Dhillon functional score of the elbow joint was excellent in 1l cases and good in 3 cases in the arthroscope group,and excellent in9 cases,good inilcases and fair inIcase in the inceision group.The arthroscopegroup was superior to the incision group(P<0.05).At the last follow-up,the Dhillon functional score of the elbow joint was excellent in 13 cases and good

关 键 词：肘关节 关节镜 闭合复位 肱骨外髁骨折 Jakob分型 

分 类 号：R726.8[医药卫生—儿科]