儿童不稳定型肱骨外髁骨折超声引导下闭合复位失败的危险因素分析  

Risk factors for ultrasound‑guided closed reduction failure of unstable lateral humeral condylar fractures in children

作　　者：袁悦 贾国强 谢康 申向阳 金斌[1] 袁毅[1] Yuan Yue;Jia Guoqiang;Xie Kang;Shen Xiangyang;Jin Bin;Yuan Yi(Department of Orthopedics,Anhui Provincial Children′s Hospital,Hefei 230051,China)

机构地区：[1]安徽省儿童医院骨科,合肥230051

出　　处：《中华创伤杂志》2024年第7期623-627,共5页Chinese Journal of Trauma

基　　金：国家临床重点专科;安徽省卫生健康委员会(AHWJ2023BAa0106);安徽医科大学基金(2022xkj111)。

摘　　要：目的探讨儿童不稳定型肱骨外髁骨折超声引导下闭合复位失败的危险因素。方法采用回顾性病例对照研究分析2022年1月至2023年8月安徽省儿童医院收治的158例不稳定型肱骨外髁骨折患儿的临床资料,其中男102例,女56例;年龄1~14岁[5(4,8)岁]。根据超声引导下闭合复位是否成功,将患儿分为复位成功组(136例)和复位失败组(22例)。记录两组性别、年龄、体重指数、侧别、受伤至手术时间、骨块矢状面移位方向、Milch分型、Song分型、是否合并皮下瘀斑、是否夜间手术、是否术者经验缺乏、是否合并肘关节脱位等情况。通过单因素分析和二元Logistic回归分析评估并确定儿童不稳定型肱骨外髁骨折超声引导下闭合复位失败的独立危险因素。结果单因素分析结果显示,复位成功组与复位失败组受伤至手术时间、骨块矢状面移位方向、是否术者经验缺乏比较,差异均有统计学意义(P<0.01);两组性别、年龄、体重指数、侧别、Milch分型、Song分型、是否合并皮下瘀斑、是否夜间手术和是否合并肘关节脱位比较,差异均无统计学意义(P>0.05)。二元Logistic回归分析结果表明,受伤至手术时间≥5 d(OR=1.47,95%CI 1.17,1.86,P<0.01)、骨块矢状面前方移位(OR=7.07,95%CI 1.79,27.98,P<0.01)和术者经验缺乏(OR=4.67,95%CI 1.21,18.05,P<0.05)与儿童不稳定型肱骨外髁骨折超声引导下闭合复位失败显著相关。结论受伤至手术时间≥5 d、骨块矢状面前方移位和术者经验缺乏是儿童不稳定型肱骨外髁骨折超声引导下闭合复位失败的独立危险因素。Objective To explore the risk factors of ultrasound⁃guided closed reduction failure of unstable lateral humeral condylar fractures in children.Methods A retrospective case⁃control study was conducted to analyze the clinical data of 158 children with unstable lateral humeral condyle fractures admitted to Anhui Provincial Children′s Hospital from January 2022 to August 2023,including 102 males and 56 females,aged 1⁃14 years[5(4,8)years].The patients were divided into reduction success group(n=136)and reduction failure group(n=22)according to the results of ultrasound⁃guided closed reduction.The gender,age,body mass index,injury side,time from injury to surgery,direction of sagittal plane displacement of the fracture fragment,Milch classification,Song classification,concomitant subcutaneous bruising or not,nighttime surgery or not,surgeons′lack of experience or not,and concomitant elbow dislocation or not were recorded in both groups.Univariate analysis and binary Logistic regression analysis were used to evaluate and identify the independent risk factors for ultrasound⁃guided closed reduction failure of unstable lateral humeral condylar fractures in children.Results Univariate analysis showed that there were significant differences in the time from injury to surgery,direction of sagittal plane displacement of the fracture fragment,and surgeons′lack of experience or not between the reduction success group and reduction failure group(P<0.01),while there were no significant differences in gender,age,body mass index,injury side,Milch classification,Song classification,concomitant subcutaneous bruising or not,nighttime surgery or not,or concomitant elbow dislocation or not between the two groups(P>0.05).Binary Logistic regression analysis showed that the time from injury to surgery≥5 days(OR=1.47,95%CI 1.17,1.86,P<0.01),sagittal anterior displacement of the fracture fragment(OR=7.07,95%CI,1.79,27.98,P<0.01)and surgeons′lack of experience(OR=4.67,95%CI,1.21,18.05,P<0.05)were significantly correlated w

关 键 词：儿童 肱骨骨折 超声检查 肘关节 危险因素 

分 类 号：R726.8[医药卫生—儿科]