儿童肱骨髁上骨折闭合复位失败的危险因素分析

Risk factors of failure in closed reduction for supracondylar fractures of humerus in children

目的探讨导致儿童肱骨髁上骨折闭合复位失败的危险因素，从而指导临床治疗。方法回顾性分析2008年2月至2013年2月于本院治疗的138例肱骨髁上骨折患儿的临床资料，记录其年龄、BMI指数、受伤机制、骨折类型、受伤至手术时间、最大初始移位（对位及旋转）。采用均值比较或卡方检验对以上因素进行单因素分析，再采用多因素logistic分析对可能的危险因素进行分析，以明确肱骨髁上骨折闭合复位失败的相关因素。结果单因素分析显示BMI指数、骨折类型、受伤至手术时间、最大初始移位与儿童肱骨髁上骨折闭合复位失败有显著相关性，多因素Logistic回归分析显示，骨折类型、受伤至手术时间、最大初始移位是儿童肱骨髁上骨折闭合复位失败的独立危险因素。结论伤后肿胀高峰期、GartlandⅢ型骨折、初始移位大的患儿闭合复位失败机率高，选择复位及固定方式时应仔细考虑这些危险因素。

Objective To investigate the risk factors of failure in closed reduction for supracon- dylar fracture of humerus in children and to guide clinical treatment. Methods Children with supracon- dylar fractures who were treated in our hospital from February 2008 to February 2013 were studied. Age, BMI index, mechanism of injury, fracture type, duration from injury to surgery, the maximum initial displacement （right position and rotation） were analyzed. Mean comparison or chisquare test was used for univariate analysis and multivariate logistic regression analysis was used to identify possi- ble risk factors. Results Univariate analysis showed that BMI index, fracture type, duration from in jury to surgery and the maximum initial displacement were significantly correlated with the failure in closed reduction. Multivariate logistic regression analysis showed that the type of fracture, duration from injury to surgery and the maximum initial displacement were independent risk factors. Conclusions Swelling peak time, Gartland type Ⅲ fractures and the maximum initial displacement are risk factors for the failure in closed reduction for supraeondylar fracture of humerus in children, which should be carefully considered when selecting reduction and fixation mode.