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[1]劉鴻豪,趙云昌,趙春節(jié).閉合復(fù)位改良外側(cè)交叉克氏針內(nèi)固定治療兒童GartlandⅡ、Ⅲ型肱骨髁上骨折的臨床研究[J].中醫(yī)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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閉合復(fù)位改良外側(cè)交叉克氏針內(nèi)固定治療兒童GartlandⅡ、Ⅲ型肱骨髁上骨折的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年11期
頁碼:
7-11
欄目:
臨床研究
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:
劉鴻豪; 趙云昌; 趙春節(jié)
(周口市中心醫(yī)院,河南 周口 466000)
Author(s):
LIU Honghao; ZHAO Yunchang; ZHAO Chunjie
Zhoukou Central Hospital,Zhoukou 466000,Henan,China
關(guān)鍵詞:
肘關(guān)節(jié);  肱骨骨折;  正骨手法;  骨折固定術(shù); 內(nèi);  克氏針;  兒童;  臨床試驗(yàn)
Keywords:
elbow joint;  humeral fractures;  bone setting manipulation;  fracture fixation; internal;  Kirschner wire;  child;  clinical trial
摘要:
目的:探討閉合復(fù)位改良外側(cè)交叉克氏針內(nèi)固定治療兒童GartlandⅡ、Ⅲ型肱骨髁上骨折的臨床療效和安全性。方法:將符合要求的78例GartlandⅡ、Ⅲ型肱骨髁上骨折患兒隨機(jī)分為改良外側(cè)克氏針組與內(nèi)外側(cè)克氏針組,每組39例。均先行骨折閉合復(fù)位,然后分別采用改良外側(cè)交叉克氏針內(nèi)固定(外側(cè)交叉克氏針內(nèi)固定后,再從骨折遠(yuǎn)端外側(cè)置入1枚克氏針固定)和內(nèi)外側(cè)交叉克氏針內(nèi)固定治療。觀察記錄患者的手術(shù)時(shí)間、住院時(shí)間、骨折愈合時(shí)間、肘關(guān)節(jié)主動活動度、前臂主動活動度及并發(fā)癥發(fā)生情況,采用Mayo肘關(guān)節(jié)功能評分標(biāo)準(zhǔn)評定總體療效。結(jié)果:改良外側(cè)克氏針組的手術(shù)時(shí)間比內(nèi)外側(cè)克氏針組短[(35.42±5.36)min,(39.68±5.03)min,t=3.619,P=0.001]。2組患者的住院時(shí)間比較,差異無統(tǒng)計(jì)學(xué)意義[(3.62±0.67)d,(3.59±0.71)d,t=0.192,P=0.848]。2組患者的骨折均愈合,骨折愈合時(shí)間的差異無統(tǒng)計(jì)學(xué)意義[(43.15±6.52)d,(45.18±6.74)d,t=1.352,P=0.180]。術(shù)后6個(gè)月時(shí),2組患者的肘關(guān)節(jié)伸直活動度、肘關(guān)節(jié)屈曲活動度、前臂旋前活動度及前臂旋后活動度比較,組間差異均無統(tǒng)計(jì)學(xué)意義(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組患者的總體療效比較,差異無統(tǒng)計(jì)學(xué)意義(Z=-0.558,P=0.577)。至術(shù)后6個(gè)月時(shí),改良外側(cè)克氏針組1例發(fā)生針道感染,經(jīng)抗炎、局部切開引流及換藥后治愈; 1例發(fā)生內(nèi)固定松動,手術(shù)取出松動克氏針,再次手術(shù)重新固定后恢復(fù)良好。內(nèi)外側(cè)克氏針組2例發(fā)生針道感染,經(jīng)抗炎、局部切開引流、換藥后治愈; 6例發(fā)生尺神經(jīng)損傷,其中1例拔除克氏針后癥狀改善,另5例給予營養(yǎng)神經(jīng)及微循環(huán)調(diào)理后緩解。2組針道感染及克氏針?biāo)蓜拥陌l(fā)生率比較,組間差異均無統(tǒng)計(jì)學(xué)意義(χ2=0.000,P=1.000; P=1.000); 改良外側(cè)克氏針組尺神經(jīng)損傷發(fā)生率低于內(nèi)外側(cè)克氏針組(χ2=4.214,P=0.034)。結(jié)論:閉合復(fù)位改良外側(cè)交叉克氏針內(nèi)固定可有效治療兒童GartlandⅡ、Ⅲ型肱骨髁上骨折,其療效與閉合復(fù)位內(nèi)外側(cè)交叉克氏針內(nèi)固定治療相當(dāng),但可有效避免尺神經(jīng)損傷,而且手術(shù)時(shí)間更短。
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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(收稿日期:2018-12-12 本文編輯:李曉樂)
更新日期/Last Update: 2019-11-10