超声引导下两种克氏针固定方式治疗儿童肱骨髁上骨折的疗效观察

马先文; 陈迪嘉; 隋聪; 刘虎

超声引导下两种克氏针固定方式治疗儿童肱骨髁上骨折的疗效观察

Observation on the therapeutic effect of two Kirschner needle fixation methods under ultrasound guidance in the treatment of supracondylar fractures of Humerus in children

摘要

摘要:
目的： 比较超声引导下闭合复位克氏针内外侧交叉固定与单纯外侧固定治疗儿童伸直型肱骨髁上骨折的临床疗效。
方法： 回顾性分析84例儿童伸直型肱骨髁上骨折（GartlandⅡ ~ Ⅳ型）患儿，按手术方式分为闭合复位内外交叉固定组（A组）、单纯外侧固定组（B组），比较两组手术时间、住院时间、骨折愈合时间、肘关节功能评分、迟发性尺神经损伤，骨折再移位率以及术后并发症等。
结果： 所有患儿均获得随访，A组及B组的平均随访时间分别为（10.31 ± 3.24）个月及（10.06 ± 3.78）个月；A组患儿的手术时间（33.84 ± 3.23）min长于B组的（28.68 ± 3.45）min，差异具有统计学意义（P ＞ 0.01）；两组患儿的骨折愈合时间分别为（37.23 ± 7.38）d、（35.67 ± 6.83）d，组间差异无统计学意义（P ＞ 0.05）； A组患儿出现2例迟发性尺神经损伤、其他并发症3例，B组患儿未发生尺发性尺神经损伤，其他并发症2例，术后并发症发生率组间差异无统计学意义（P ＞ 0.05）；2组患儿均无肘内翻、肘外翻的发生，术后8个月肘关节功能及相关指标组间比较差异无统计学意义（P ＞ 0.05）。
结论： 超声引导下闭合复位克氏针内外侧交叉固定和单纯外侧固定均是儿童肱骨髁上骨折有效的固定方式，其中内外侧交叉固定可减少术后骨折移位的可能性，但可能会引起迟发性尺神经损伤。

Abstract:
Objective To compare the clinical efficacy between ultrasound-guided closed reduction with Kirschner's needle for medial and lateral cross fixation and simple lateral fixation in the treatment of extended supracondylar fractures of humerus in children.
Methods A retrospective analysis was conducted on 84 children with extended supracondylar fractures of humerus (Gartland types Ⅱ-Ⅳ). They were divided into the closed reduction internal and external cross fixation group (Group A) and simple lateral fixation group (Group B) according to the surgical methods. The operation time, hospital stay, fracture healing time, elbow joint function score and delayed ulnar nerve injury, rate of fracture re-displacement and postoperative complications were compared between two groups.
Results All children were followed up. The average follow-up time in group A and group B were (10.31 ± 3.24) months and (10.06 ± 3.78) months, respectively. The operation time in group A was (33.84 ± 3.23) min, which was longer than that of group B (28.68 ± 3.45) min, and the difference was statistically significant (P ＜ 0.01). The fracture healing time in two groups were (37.23 ± 7.38) days and (35.67 ± 6.83) days, respectively, and there was no statistically significant difference between two groups (P ＞ 0.05). In group A, there were 2 cases of delayed ulnar nerve injury and 3 cases of other complications. In group B, no ulnar nerve injury occurred, but 2 cases of other complications. There was no statistically significant difference in the incidence of postoperative complications between two groups (P ＞ 0.05). Neither of the two groups of children had the occurrence of cubitus varus or cubitus valgus. There was no statistically significant difference in the elbow joint function and related indicators between two groups after 8 months of operation (P ＞ 0.05).
Conclusions Both ultrasound-guided closed reduction with Keshler needle for medial and lateral cross fixation and simple lateral fixation are effective fixation methods for supracondylar fractures of the humerus in children. Among them, the medial and lateral cross fixation can reduce the possibility of postoperative fracture displacement, but it may cause delayed ulnar nerve injury.

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