克氏针张力带钢丝治疗儿童Mayo Ⅱ型尺骨鹰嘴骨折

Tension band wiring in the treatment of Mayo type Ⅱ olecranon fractures in children

目的：探讨克氏针张力带钢丝治疗儿童MayoⅡ型尺骨鹰嘴骨折的手术方法、临床疗效。方法：回顾分析2008年6月至2015年10月,我院手术治疗的儿童MayoⅡ型尺骨鹰嘴骨折88例,男59例,女29例,年龄6～15岁,平均年龄9.1岁。MayoⅡA型51例,MayoⅡB型37例。采用切开复位克氏针张力带钢丝内固定,术后石膏固定1～2周后指导肘关节功能训练。结果：所有患者均获得随访,根据Broderg＆Morrey评分系统：MayoⅡA型：优40例,良7例,可4例,优良率92.16%。MayoⅡB型：优22例,良7例,可8例,优良率78.38%,经卡方检验,χ^2=3.457,P=0.063。2组病例术后Broderg＆Morrey评分及肘关节活动度应用独立样本t检验比较,其中评分t=5.816,P=0.001;屈肘度数t=13.906,P=0.001;伸肘度数t=9.328,P=0.001,旋前度数t=8.482,P=0.001;旋后度数t=8.876,P=0.001。比较克氏针髓腔进针法与双皮质固定法的优良率,做卡方检验,χ^2=4.779,P=0.029。结论：克氏针张力带钢丝治疗儿童MayoⅡ型尺骨鹰嘴骨折,具有对骨骺损伤小、固定稳定、术后可早期活动、肘关节功能恢复好等优点。克氏针双皮质固定对于增加稳定性、减少退针率有显著效果。Mayo分型对指导治疗、评估预后有一定帮助。严格把握手术适应证、规范操作、术后早期功能训练,是提高疗效、减少并发症的有效途径。

Objective：To investigate the methods,and clinical therapeutic efficacy of tension band wiring in the treatment of Mayo typeⅡ olecranon fractures in children. Methods：Totally 88 patients of Mayo typeⅡolecranon fractures were enrolled and their clinical data were analyzed retrospectively from June 2008 to October 2015. The patients include 59 male cases and 29 female cases,aged from 6 years old to 15 years old（9.1 years old on average）. There are 51 cases of Mayo typeⅡA and 37 cases of Mayo type ⅡB. Faculty training of elbow was carried out after one or two weeks of plaster cast. Results：All cases were followed up. According to Broderg Morrey score system,Mayo typeⅡA：40 patients were evaluated as excellent,7 as good,4 as fair;the fineness rate was 92.16%. Mayo type ⅡB：22 patients were evaluated as excellent,7 as good,8 as fair;the fineness rate was 78.38%. According to χ^2 test,χ^2=3.457,P=0.063. According to independent sample t-test：Broderg Morrey score,t=5.816,P=0.001; elbow flexion degree,t=13.906,P=0.001;elbow stretch degree,t=9.328,P=0.001;pronation degree,t=8.482,P=0.001;supination degree,t=8.876,P=0.001. χ^2 test was applied to compare the failure rate of transcortical wire orientation and intramedullary wire orientation,χ^2=4.779,P=0.029. Conclusion：With advantages of less epiphyseal injury,stable fixation,early post-operation training,good elbow joint function recovery,tension band wiring is effective in the treatment of Mayo type Ⅱ olecranon fractures in children. Transcortical wire orientation can increase the stability of wires,and reduce the removal of metal obviously. Mayo type can help to guide the treatment and evaluate the prognosis.Strict follow of the operation indication,proper way of operation,and early faculty training can enhance the therapeutic efficacy and reduce complications effectively.