摘要
目的:探讨闭合复位改良外侧交叉克氏针内固定治疗儿童Gartland Ⅱ、Ⅲ型肱骨髁上骨折的临床疗效和安全性。方法:将符合要求的78例Gartland Ⅱ、Ⅲ型肱骨髁上骨折患儿随机分为改良外侧克氏针组与内外侧克氏针组,每组39例。均先行骨折闭合复位,然后分别采用改良外侧交叉克氏针内固定(外侧交叉克氏针内固定后,再从骨折远端外侧置入1枚克氏针固定)和内外侧交叉克氏针内固定治疗。观察记录患者的手术时间、住院时间、骨折愈合时间、肘关节主动活动度、前臂主动活动度及并发症发生情况,采用Mayo肘关节功能评分标准评定总体疗效。结果:改良外侧克氏针组的手术时间比内外侧克氏针组短[(35.42±5.36)min,(39.68±5.03)min,t=3.619,P=0.001]。2组患者的住院时间比较,差异无统计学意义[(3.62±0.67)d,(3.59±0.71)d,t=0.192,P=0.848]。2组患者的骨折均愈合,骨折愈合时间的差异无统计学意义[(43.15±6.52)d,(45.18±6.74)d,t=1.352,P=0.180]。术后6个月时,2组患者的肘关节伸直活动度、肘关节屈曲活动度、前臂旋前活动度及前臂旋后活动度比较,组间差异均无统计学意义(5.46°±1.23°,5.38°±1.19°,t=0.292,P=0.771;136.72°±7.85°,136.84°±7.52°,t=0.069,P=0.945;74.21°±4.89°,75.01°±4.26°,t=0.770,P=0.443;73.95°±4.37°,74.02°±4.16°,t=0.072,P=0.942)。2组患者的总体疗效比较,差异无统计学意义(Z=-0.558,P=0.577)。至术后6个月时,改良外侧克氏针组1例发生针道感染,经抗炎、局部切开引流及换药后治愈;1例发生内固定松动,手术取出松动克氏针,再次手术重新固定后恢复良好。内外侧克氏针组2例发生针道感染,经抗炎、局部切开引流、换药后治愈;6例发生尺神经损伤,其中1例拔除克氏针后症状改善,另5例给予营养神经及微循环调理后缓解。2组针道感染及克氏针松动的发生率比较,组间差异均无统计学意义(χ2=0.000,P=1.000;P=1.000);改
Objective:To explore the clinical curative effects and safety of closed reduction and modified lateral cross Kirschner wire internal fixation for treatment of Gartland type Ⅱ and Ⅲ humeral supracondylar fractures in children.Methods:Seventy-eight children with Gartland type Ⅱ and Ⅲ humeral supracondylar fractures were enrolled in the study and were randomly divided into modified lateral Kirschner wire group and medial-lateral Kirschner wire group,39 cases in each group.All children in the 2 groups were treated with closed reduction,and then were treated with modified lateral cross Kirschner wire internal fixation and medial-lateral cross Kirschner wire internal fixation respectively.The operative time,hospital stay,fracture healing time,active range of motion(ROM)of elbow,active ROM of forearm and complication incidences were recorded and compared between the 2 groups,and the total curative effects were evaluated according to Mayo elbow performance scores.Results:The operative time was shorter in modified lateral Kirschner wire group compared to medial-lateral Kirschner wire group(35.42+/-5.36 vs 39.68+/-5.03 minutes,t=3.619,P=0.001).There was no statistical difference in hospital stay between the 2 groups(3.62+/-0.67 vs 3.59+/-0.71 days,t=0.192,P=0.848).All fractures healed in the 2 groups,and there was no statistical difference in fracture healing time between the 2 groups(43.15+/-6.52 vs 45.18+/-6.74 days,t=1.352,P=0.180).There was no statistical difference in elbow extension range,elbow flexion range,forearm pronation range and forearm supination range between the 2 groups at 6 months after the surgery(5.46+/-1.23 vs 5.38+/-1.19 degrees,t=0.292,P=0.771;136.72+/-7.85 vs 136.84+/-7.52 degrees,t=0.069,P=0.945;74.21+/-4.89 vs 75.01+/-4.26 degrees,t=0.770,P=0.443;73.95+/-4.37 vs 74.02+/-4.16 degrees,t=0.072,P=0.942).There was no statistical difference in total curative effect between the 2 groups(Z=-0.558,P=0.577).At 6 months after the surgery,the pin hole infection was found in 1 child in modified lateral
作者
刘鸿豪
赵云昌
赵春节
LIU Honghao;ZHAO Yunchang;ZHAO Chunjie(Zhoukou Central Hospital,Zhoukou 466000,Henan,China)
出处
《中医正骨》
2019年第11期7-11,16,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
肘关节
肱骨骨折
正骨手法
骨折固定术
内
克氏针
儿童
临床试验
elbow joint
humeral fractures
bone setting manipulation
fracture fixation
internal
Kirschner wire
child
clinical trial
