克氏针可吸收缝线张力带固定治疗儿童尺骨鹰嘴骨折

Open reduction and internal fixation with removable Kirschner wires and absorbable sutures for olecranon fractures in children

目的探讨克氏针可吸收缝线张力带固定治疗儿童尺骨鹰嘴骨折的手术方法与临床疗效。方法对本院2015年1月至2017年1月采用切开复位克氏针可吸收缝线张力带固定的尺骨鹰嘴骨折患儿临床资料进行回顾性分析。根据Murphy等人提出的鹰嘴骨折评分系统对患儿进行评分,临床评估共15分(包括术后疼痛、功能、活动范围3个方面),影像学评估4分。总分>18分为优秀,17分为良好,16分为一般,<16分为差。结果所有患儿均获随访,随访时间6～28个月,平均随访时间(16.16±6.15)个月。根据Murphy评分标准,平均疼痛评分(4.86±0.35)分,功能评分(5.00±0.00)分,运动范围评分(4.86±0.35)分,影像学评分(4.00±0.00分),平均总分(18.73±0.69)分。随访结果优秀26例,良4例,一般0例,差0例。随访结果优秀的病例中,22例为单纯尺骨鹰嘴骨折,其中1例伴桡骨颈骨折,3例伴肱骨外髁骨折。随访结果良的病例中,3例伴桡骨颈骨折,1例伴肱骨外髁骨折。结论应用克氏针可吸收缝线张力带固定治疗儿童尺骨鹰嘴骨折,具有骨骺损伤小、固定效果可靠、皮肤刺激小、费用低廉、术后可早期活动、肘关节功能恢复好等优点,是治疗儿童尺骨鹰嘴骨折切实可行的方法。

Objective To explore the clinical approaches and therapeutic efficacy of open reduction and internal fixation with removable Kirschner wires and absorbable sutures for olecranon fractures in children.Methods Retrospective analyses were performed for the clinical data of children with olecranon fracture undergoing open reduction and Kirschner wire absorbable suture fixation from January 2015 to January 2017. According to the Murphy＇s olecranon fracture scoring system,postoperative pain,function and range of motion were evaluated in three aspects. Imaging evaluation was 4 points out of 15. The total score was above 18 points for excellence,17 points for good,16 points for fair and under 16 for poor. Results The average followe-up period was（ 6 ～ 28）（ 16. 16 ± 6. 15） months. According to the Murphy＇s scoring system,pain score was 4. 86 ± 0. 35,functional score 5. 00 ± 0. 00,range of motion 4. 86 ± 0. 35,imaging score 4. 00 ± 0. 00 and total score 18. 73 ±0. 69 points. The outcomes were excellent（ n = 26）,good（ n = 4）,fair（ n = 0） and poor（ n = 0）. Among excellent cases,the fractures were of pure olecranon（ n = 22）,radius neck（ n = 1） and lateral humeral condyle（ n = 3）; among good cases,there were cocurrent fractures of radial neck（ n = 3） and lateral humeral condyle（ n = 1）. Conclusion With advantages of minimal epiphyseal injury,stable fixation,early postoperative training and excellent elbow joint function recovery,open reduction and internal fixation with removable Kirschner wires and absorbable sutures is efficacious for olecranon fractures in children.