[1]刘鸿豪,赵云昌,赵春节.闭合复位改良外侧交叉克氏针内固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的临床研究[J].中医正骨,2019,31(11):7-11.
　LIU Honghao,ZHAO Yunchang,ZHAO Chunjie.A clinical study of closed reduction and modified lateral cross Kirschner wire internal fixation for treatment of Gartland typeⅡandⅢhumeral supracondylar fractures in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(11):7-11.
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闭合复位改良外侧交叉克氏针内固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年11期
页码:
7-11
栏目:
临床研究
出版日期:
2019-11-20

文章信息/Info

Title:
A clinical study of closed reduction and modified lateral cross Kirschner wire internal fixation for treatment of Gartland typeⅡandⅢhumeral supracondylar fractures in children
作者:
刘鸿豪; 赵云昌; 赵春节
(周口市中心医院,河南 周口 466000)
Author(s):
LIU Honghao; ZHAO Yunchang; ZHAO Chunjie
Zhoukou Central Hospital,Zhoukou 466000,Henan,China
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
Keywords:
elbow joint;  humeral fractures;  bone setting manipulation;  fracture fixation; internal;  Kirschner wire;  child;  clinical trial
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GartlandⅡ、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GartlandⅡ、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); 改良外侧克氏针组尺神经损伤发生率低于内外侧克氏针组(χ2=4.214,P=0.034)。结论:闭合复位改良外侧交叉克氏针内固定可有效治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折,其疗效与闭合复位内外侧交叉克氏针内固定治疗相当,但可有效避免尺神经损伤,而且手术时间更短。
Abstract:
Objective:To explore the clinical curative effects and safety of closed reduction and modified lateral cross Kirschner wire internal fixation for treatment of Gartland typeⅡandⅢhumeral supracondylar fractures in children.Methods:Seventy-eight children with Gartland typeⅡandⅢhumeral 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 Kirschner wire group and 2 children in medial-lateral Kirschner wire group,and the pin hole healed after treatment with anti-inflammatory,partial incision and drainage and dressing change.The loosening of internal fixator was found in 1 child in modified lateral Kirschner wire,and the fracture recovered well after the Kirschner wire was removed and refixed.Ulnar nerve injury was found in 6 children in medial-lateral Kirschner wire group,the symptom was improved in one child after removal of Kirschner wire and in the other 5 children after application of neurotrophic drugs and regulation of microcirculation.There was no statistical difference in the incidence rates of postoperative pin hole infection and Kirschner wire loosening between the 2 groups(χ2=0.000,P=1.000; P=1.000).The incidence rate of ulnar nerve injury was lower in modified lateral Kirschner wire group compared to medial-lateral Kirschner wire group(χ2=4.214,P=0.034).Conclusion:Closed reduction and modified lateral cross Kirschner wire internal fixation is effective for treating Gartland typeⅡandⅢhumeral supracondylar fractures in children,and it is similar to closed reduction and medial-lateral cross Kirschner wire internal fixation in the curative effect,while the former can effectively avoid ulnar nerve injury and need shorter operative time compared to the latter.

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备注/Memo

备注/Memo:
(收稿日期:2018-12-12 本文编辑:李晓乐)
更新日期/Last Update: 2019-11-10