新型带孔克氏针张力带治疗成人尺骨鹰嘴骨折的病例对照研究

Case control study on a new Kirschner wire tension band with hole in the treatment of adult olecranon fractures in adults

目的:通过对比带孔克氏针与普通克氏针张力带治疗成人尺骨鹰嘴骨折的疗效,以指导临床手术方案的选择。方法:回顾性分析2011年7月至2015年10月采用带孔克氏针或普通克氏针张力带治疗的尺骨鹰嘴骨折病例,经筛选后共49例。带孔克氏针组21例(A组),男12例,女9例,年龄(37.6±8.2)岁;普通克氏针组28例(B组),男18例,女10例,年龄(38.9±7.3)岁。两组患者的一般资料差异无统计学意义。观察比较两组在手术时间、放射次数、骨折愈合时间、并发症及术后肘关节功能评分等方面的差异,并行统计学分析。结果:A组手术时间(60.4±10.7)min,放射次数(12.5±2.9)次;B组手术时间(62.3±11.8)min,放射次数(13.7±3.8)次,两组在手术时间、放射次数上差异均无统计学意义。A组骨折愈合时间(13.2±2.6)周,无退针、皮肤激惹等并发症发生;B组骨折愈合时间(14.6±1.8)周,出现并发症(退针6例,皮肤激惹7例,内固定失效2例),A组骨折愈合时间短于B组。两组患者术后肘关节功能评估,A组疼痛(41.0±3.5)分,运动功能(18.0±2.1)分,稳定性(9.0±0.8)分,日常活动(18.0±4.3)分,总平均分87.0±7.8;B组疼痛(39.0±5.6)分,运动功能(17.0±3.2)分,稳定性(8.0±2.4)分,日常活动(16.0±5.2)分,总平均分83.0±10.7,两组各分项及总平均分的差异无统计学意义。结论:相对于普通克氏针,带孔克氏针张力带治疗尺骨鹰嘴骨折能缩短骨折愈合时间、明显减少并发症的发生,且不影响术后功能的恢复,适合临床开展使用。

Objective：To compare the efficacy of Kirschner wire tension band with hole and common Kirschner wire tension band in the treatment of olecranon fractures in adults,so as to guide the selection of clinical surgical procedures. Methods：From July 2011 to October 2015,a total of 49 patients with olecranon fractures underwent open reduction and fixation with Kirschner wire tension band,which were retrospectively analyzed. Of the 49 patients,21 patients（group A） were treated with Kirschner wire tension band with hole,including 12 males and 9 females,with an average age of（37.6 ±8.2） years old;28 patients（group B） were treated with common Kirschner wire,including 18 males and 10 females,with an average age of（38.9±7.3） years old. There were no statistically significant differences between the two groups in general data. The differences of operative duration,frequency of radiation,fracture healing time,complications and postoperative elbow function scores between the two groups were observed and analyzed by parallel statistical analysis. Results：In group A,the operative duration was（60.4±10.7） min,the average number of radiation times was（12.5±2.9）;in group B,the operative duration was（62.3±11.8）min,and the average radiation times was（13.7±3.8）;there was no significant difference in operative time and radiation times between the two groups（P 0.05）. In group A,the fracture healing time was（13.2±2.6） weeks without K wire migration,skin irritation and other complications; and fracture healing time in group B was（14.6±1.8） weeks with complications（K wire migration in 6 cases,skin irritation in 7 cases,internal fixation failure in 2 cases）;the fracture healing time of group A was shorter than that in group B. Evaluation of elbow joint function in two groups of patients after operation showed that in group A,pain score was 41.0±3.5,movement function score was 18.0±2.1,stability score was 9.0±0.8,daily activities score was 18.0±4.3,the total average score was 87.0 ±7.8; and in group B, the pain score was 39.0 ±5.6,movement function score was 17.0 ±3.2,the stability score was 8.0±2.4,daily activities score was 16.0±5.2,the total average score was 83.0±10.7. There were no statistically significant in the scores between the two groups. Conclusion：Compared with ordinary Kirschner wire,the treatment of olecranon fracture with Kirschner tension band with hole can shorten the time of fracture healing,significantly reduce the occurrence of complications,and do not affect the recovery of postoperative function,which is suitable for clinical use.