摘要
目的探讨克氏针穿针外固定联合闭合复位治疗GartlandⅡ型儿童肱骨髁上骨折的临床效果及对患儿影像学指标的影响。方法选取2020年5月—2022年5月在杭州市儿童医院治疗的60例GartlandⅡ型儿童肱骨髁上骨折患儿为研究对象,采用随机数字表法分为观察组和对照组,每组各30例。对照组患儿给予闭合复位联合石膏托外固定治疗,观察组患儿给予闭合复位联合克氏针穿针外固定治疗。比较两组患儿骨折愈合时间,术后3个月的Mayo功能评分和按肘关节功能Flynn评分标准评价的疗效,并随访术后3个月和12个月的影像学指标和并发症发生情况。结果观察组患儿骨折愈合时间[(25.61±2.45)d]短于对照组[(28.06±2.29)d],术后3个月的Mayo功能评分[(91.24±4.35)分]高于对照组[(86.33±5.06)分],差异均有统计学意义(t=4.001、4.030,均P<0.05)。观察组患儿术后3个月的治疗优良率(96.67%)高于对照组(73.33%),差异有统计学意义(χ^(2)=4.628,P<0.05)。术后3个月,观察组患儿过伸角[(3.33±0.34)°]小于对照组[(5.64±0.51)°],屈曲角[(140.91±3.20)°]大于对照组[(135.43±3.84)°],差异均有统计学意义(t=20.642、6.005,均P<0.05),两组患儿的关节活动范围(ROM)[(151.64±4.89)°、(151.07±4.83)°]和Baumann角[(77.86±3.29)°、(77.14±3.25)°]比较,差异均无统计学意义(t=0.454、0.853,均P>0.05)。术后12个月,两组患儿过伸角[(3.20±0.31)°、(3.34±0.33)°]、屈曲角[(142.45±3.24)°、(140.89±3.67)°]、ROM[(153.04±4.97)°、(152.89±5.16)°]及Baumann角[(78.63±3.32)°、(78.11±3.75)°]比较,差异均无统计学意义(t=1.694、1.745、0.115及0.569,均P>0.05)。两组患儿肘外翻、感染、尺神经损伤、肘关节僵硬及肘部骨化性肌炎发生率比较,差异均无统计学意义(均P>0.05)。结论克氏针穿针外固定联合闭合复位治疗GartlandⅡ型儿童肱骨髁上骨折具有易复位,固定稳定,具有利于早期功能锻炼的特点,能够缩短骨折愈合时间,提高早期治疗优良率,且术后早期活动度恢复满意,可有效促进康复。
Objective To investigate the effect of Kirschner wire external fixation combined with closed reduction in the treatment of Gartland typeⅡsupracondylar humerus fractures in children and its influence on imaging indexes.Methods From May 2020 to May 2022,60 children with supracondylar humerus fractures of Gartland typeⅡin Hangzhou Children's Hospital were selected as the study objects,and were randomly divided into an observation group and a control group with 30 cases in each group.The control group was treated with closed reduction combined with plaster external fixation,while the observation group was treated with closed reduction combined with Kirschner wire external fixation.The fracture healing time,Mayo function score and the efficacy evaluated according to the Flynn score standard for elbow joint function at 3 months after surgery were compared,and imaging indicators and complications were followed up at 3 and 12 months after surgery.Results The fracture healing time of the observation group[(25.61±2.45)days]was shorter than that of the control group[(28.06±2.29)days],and the Mayo functional score[(91.24±4.35)points]at 3 months after surgery was higher than that of the control group[(86.33±5.06)points],and the difference was statistically significant(t=4.001,4.030,all P<0.05).The excellent and good treatment rate of the observation group at 3 months after surgery(96.67%)was higher than that of the control group(73.33%),and the difference was statistically significant(χ^(2)=4.628,P<0.05).After 3 months of surgery,the observation group had a smaller overextension angle[(3.33±0.34)°]than the control group[(5.64±0.51)°],and a greater flexion angle[(140.91±3.20)°]than the control group[(135.43±3.84)°],with statistically significant differences(t=20.642,6.005,all P<0.05).There was no statistically significant difference in joint range of motion(ROM)[(151.64±4.89)°ratio(151.07±4.83)°]and Baumann angle[(77.86±3.29)°ratio(77.14±3.25)°]between the two groups at 3 months after surgery(t=0.454,0.853,all P>0.05).Until 12 months after surgery,there were no statistically significant differences in the two groups'overextension angle[(3.20±0.31)°ratio(3.34±0.33)°],flexion angle[(142.45±3.24)°ratio(140.89±3.67)°],ROM[(153.04±4.97)°ratio(152.89±5.16)°],and Baumann angle[(78.63±3.32)°ratio(78.11±3.75)°](t=1.694,1.745,0.115,0.569,all P>0.05).There was no significant difference in the incidence of cubitus valgus,infection,ulnar nerve injury,elbow joint stiffness,and elbow myositis ossificans between the two groups(P>0.05).Conclusion The treatment of Gartland typeⅡsupracondylar humerus fractures in children with Kirschner wire external fixation combined with closed reduction has the characteristics of easy reduction,stable fixation,and is conducive to early functional exercise.It can shorten the fracture healing time,improve the excellent and good rate of early treatment,and restore the early activity after operation with satisfaction,which can effectively promote rehabilitation.
作者
王浩然
任玮玮
刘子祥
王汉卿
吴鹏
戴蓉丹
洪东升
WANG Hao-ran;REN Wei-wei;LIU Zi-xiang;WANG Han-qing;WU Peng;DAI Rong-dan;HONG Dong-sheng(Department of Orthopedics,Hangzhou Children's Hospital,Hangzhou,Zhejiang 310014,China;不详)
出处
《中国妇幼保健》
CAS
2023年第17期3238-3241,共4页
Maternal and Child Health Care of China
基金
浙江省杭州市科学技术项目(2022WJC073)。
关键词
克氏针穿针外固定
闭合复位
GartlandⅡ型
儿童
肱骨髁上骨折
Kirschner wire puncture and external fixation
Closed reset
Gartland typeⅡ
Children
Supracondylar humerus fractures
