儿童陈旧性肱骨外髁骨折两种内固定方法疗效比较

Comparison of two kinds of internal fixation methods in children with old humeral condyle fracture

目的:比较克氏针和空心钉切开复位内固定治疗儿童陈旧性肱骨外髁骨折的疗效。方法:回顾性分析2010年1月至2016年1月收治的31例儿童陈旧性肱骨外髁骨折的临床资料。31例患儿依据内固定方法分为两组,克氏针组16例,其中男10例,女6例,空心钉组15例,男8例,女7例。术后对患儿进行随访,末次复查时根据Dhillon标准对患儿肘关节功能进行评估。结果:31例患儿均获随访,随访时间2~4 a。术后6~12周X线片显示31例骨折均愈合。空心钉组患儿术中出血量为(19.53±4.36)m L,克氏针组为(19.94±6.44)m L,2组间差异无统计学意义(P>0.05)。空心钉组患者手术时间为(85.87±12.44)min,高于克氏针组(76.94±11.82)min(P=0.049 6)。末次随访克氏针组肘关节功能优良率(93.8%)与空心钉组优良率(86.7%)相比,差异无统计学意义(P>0.05)。结论:克氏针固定与空心钉固定治疗儿童陈旧性肱骨外髁骨折均可获得满意效果,远期效果有待进一步观察。

Aim：To observe and compare the curative effect of Kirschner wire and hollow nail in open reduction and internal fixation for the treatment of old humeral condylar fractures in children. Methods： A retrospective analysis of 31 children with old humeral condyle fracture were allocated into 2 groups according to fixation methods,the Kirschner wire group of 16 patients（10 males,6 females）,and the hollow nail group of 15 patients（8 males and 7 females）. All the children were followed up after surgery,and at the time of the last review,these children＇s elbows were evaluated according to Dhillon criteria. Results： All the children were followed up for 2 ~ 4 years. The X-ray showed that all the fractures were healed after 6 ~ 12 weeks. The intraoperative average amount of bleeding in the Kirschner wire group was（19. 94 ± 6. 44）m L,in the hollow nail group was（ 19. 53 ± 4. 36） m L,and there was no significant difference between the two groups（P〈0. 05）. The mean operative time was（85. 87 ± 12. 44） min in the hollow nail group,higher than that[（76. 94 ±11. 82） min] in the Kirschner wire group（ P = 0. 049 6）. At the last follow-up,the excellent and good rate of the elbows in the Kirschner wire group（93. 8%） had no significant difference from that（86. 7%） of the hollow nail group（ P〈0. 05）.Conclusion： Kirschner wire fixation and hollow nail fixation are effective in treating old humeral condyle fracture of children,but the long-term effect needs further observation.