不同旋转方式屈曲桡偏型儿童肱骨髁上骨折尺神经损伤和切开复位的危险因素分析  

Rotation on X&Y-axis on radiography as a reliable prediction of ulnar nerve injury and open reduction in lateral flexion supracondylar humeral fractures:a retrospective cohort study

作　　者：顾然 贾国强 孟连 林昱东 孟阁 袁悦 Gu Ran;Jia Guoqiang;Meng Lian;Lin Yudong;Meng Ge;Yuan Yue(Department of Orthopedics,Children's hospital of Fudan University Anhui hospital,Hefei 230051,China)

机构地区：[1]复旦大学附属儿科医院安徽医院骨科,合肥230051

出　　处：《中华小儿外科杂志》2024年第6期516-520,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(61976008)。

摘　　要：目的比较不同旋转方式的屈曲桡偏型儿童肱骨髁上骨折与尺神经损伤、切开复位的关系,并评估发生轴向旋转的危险因素。方法回顾性分析2012年1月至2021年12月就诊于复旦大学附属儿科医院安徽医院的152例WilkinsⅢ型肱骨髁上骨折患儿资料,所有患儿尺神经损伤发生率为13%(20/152),切开复位率为22%(34/152)。根据正侧位X线平片结果,在坐标轴上将远端骨折块的旋转方式分为ⅢA型(X轴旋转,Y轴轻度旋转或无旋转)和ⅢB型(X轴旋转并伴有Y轴明显旋转)。比较两种类型患儿的性别、年龄、骨折侧别、骨折位置高低、身体质量指数、尺神经损伤和切开复位情况的差异,组间比较采用t检验或χ^(2)检验或Fisher确切概率法;采用单因素方差分析及多因素logistic回归分析引起Y轴明显旋转的危险因素。结果152例患儿中ⅢA型50例,ⅢB型102例,两种类型患儿在性别、骨折侧别、身体质量指数差异无统计学意义(均P>0.05),在尺神经损伤发生率(χ^(2)=5.47,P=0.019)、骨折位置(χ^(2)=11.48,P=0.001)、切开复位率(χ^(2)=8.86,P=0.001)差异有统计学意义。ⅢB型发生尺神经损伤的风险约是ⅢA型的5倍(OR=5.143,95%CI为1.414~23.125,P=0.019)。ⅢB型行切开复位的风险约是ⅢA型的5倍(OR=4.729,95%CI为1.584~14.495,P=0.003)。在屈曲桡偏Ⅲ型骨折中,伴有尺神经损伤切开复位的风险是无尺神经损伤的10倍(OR=9.816,95%CI为3.503~27.508,P=0.001)。高位型肱骨髁上骨折是Y轴明显旋转的唯一危险因素(OR=3.210,95%CI为1.470~7.011,P=0.003)。结论伴有Y轴明显旋转的屈曲桡偏WilkinsⅢ型肱骨髁上骨折更容易伴发尺神经损伤,闭合复位更加困难,其中高位型肱骨髁上骨折是引起Y轴明显旋转的独立危险因素。Objective To explore the relationship between rotation and ulnar nerve injury(UNI)or open reduction in Wilkins type-Ⅲlateral flexion supracondylar humeral fractures(SCHFs)and examine the risk factors associated with rotation.Methods The relevant clinical data of Wilkins type-Ⅲlateral flexion SCHFs were collected from January 1,2012 to December 31,2021.Rotation direction of distal fragment was classified as two types ofⅢA(only X-axis rotation)andⅢB(X/Y-axis rotation)on radiography according to biomechanical theory.Demographic profiles,incidence of dual-type rotation,odd ratios(ORs)of UNI or open reduction and risk factors of X/Y-axis rotation were recorded.Results A total of 152 children were recruited(ⅢA,n=50 versusⅢB,n=102).UNI rate was 13%and open reduction rate 22%.UNI rate ofⅢB was 5-fold higher than ofⅢA(OR=5.143,95%CI:1.414-23.125,P=0.019)and open reduction rate ofⅢB nearly 5-fold higher than ofⅢA(OR=4.729,95%CI:1.584-14.495,P=0.003).UNI children had a higher risk to open reduction than those without UNI in type-Ⅲ(OR=9.816,95%CI:3.503-27.508,P=0.001).Multiple regression analysis revealed that high level fracture was a risk factor of X/Y-axis rotation(OR=3.210,95%CI:1.470-7.011,P=0.003).Conclusions Lateral flexion type-ⅢSCHFs with X/Y-axis rotation may predict UNI and open reduction and a high level fracture is a risk factor associated with this rotation.

关 键 词：肱骨骨折 屈曲型肱骨髁上骨折 神经损伤 切开复位 

分 类 号：R726.8[医药卫生—儿科]