股骨远端90°锁定钢板与克氏针治疗大龄儿童股骨髁上骨折的疗效比较  

Comparison effect between 90°locking plate of distal femur and Kirschner wire for treatment of femoral supracondylar fracture in older children

作　　者：张远鉴 王意菊 尹同珍[1] 刘阳[1] ZHANG Yuan-jian;WANG Yi-ju;YIN Tong-zhen;LIU Yang(Dept of Pediatric Orthopaedics and Bone Tumors,Cangzhou Integrated Traditional Chinese and Western Medicine Hospital of Hebei Province,Cangzhou,Hebei 061013,China)

机构地区：[1]河北省沧州中西医结合医院小儿骨科、骨肿瘤科,河北沧州061013 [2]沧州市中心医院骨科,河北沧州061017

出　　处：《临床骨科杂志》2024年第3期424-428,共5页Journal of Clinical Orthopaedics

基　　金：河北省卫健委医学科学研究课题计划(编号:20200616)。

摘　　要：目的比较股骨远端90°锁定钢板与克氏针治疗大龄儿童股骨髁上骨折的疗效。方法采用随机数字表法将61例大龄儿童股骨髁上不稳定型骨折患儿分为观察组(31例,采用股骨远端90°锁定钢板治疗)和对照组(30例,采用闭合或切开复位克氏针治疗)。记录两组手术情况、疼痛VAS评分、骨折愈合情况以及骨折再移位率,采用Johner-Wruhs标准评价疗效。结果患儿均获得随访,时间6~24个月。手术时间、术中透视次数观察组短(少)于对照组(P<0.05)。术后1个月疼痛VAS评分观察组低于对照组(P<0.05)。两组骨折均愈合,时间3~5个月。末次随访时采用Johner-Wruhs标准评价的疗效优良率观察组高于对照组(P<0.05)。随访期间观察组1例(3.2%)骨折再移位,对照组8例(26.7%)骨折再移位,骨折再移位率观察组小于对照组(P<0.05)。结论股骨远端90°锁定钢板治疗大龄儿童股骨髁上骨折,无需塑形、固定牢固、符合生物力学特点,效果良好;与克氏针治疗相比,手术时间更短,术中透视次数更少,患儿可以更早功能锻炼,骨折再移位率更低。Objective To compare the efficacy of 90°locking plate of distal femur and Kirschner wire in the treatment of femoral supracondylar fracture in older children.Methods The 61 older children with femoral supracondylar fractures were divided into observation group(31 cases were treated with 90°locking plate of distal femur)and control group(30 cases were treated with closed or open reduction Kirschner wire)by random number table.The operation status,pain VAS,fracture healing status and fracture re-displacement rate of the two groups were recorded,and the curative effect was evaluated by Johner-Wruhs criteria.Results All patients were followed up for 6~24 months.Operation time and intraoperative fluoroscopy frequency were shorter(less)in observation group than those in control group(P<0.05).At 1 month after surgery,the pain VAS of the observation group was lower than that of the control group(P<0.05).The fractures of both groups healed within 3~5 months.At the last follow-up,the observation group was higher than control group in the excellent-good rate of efficacy evaluated with Johner-Wruhs standard(P<0.05).During the follow-up period,1 patient(3.2%)in the observation group and 8 patients(26.7%)in the control group suffered from re-displacement.The re-displacement rate in the observation group was lower than that in the control group(P<0.05).Conclusions For treatment of femoral supracondylar fracture in older children,the 90°locking plate of distal femur don′t need to shape with firm fixation,and is conformed to biomechanical characteristics,with good effect;and compared with Kirschner wire,the operation time is shorter,the intraoperative fluoroscopy times is fewer,the functional exercise can be performed earlier,and the fracture re-displacement rate is lower.

关 键 词：股骨髁上骨折 股骨远端90°锁定钢板 克氏针 儿童 

分 类 号：R726.834.2[医药卫生—儿科] R726.873.2[医药卫生—临床医学]