两种克氏针固定方法治疗儿童肱骨髁上骨折的临床疗效比较

Comparison on clinical effect of two kinds of gram needle fixation methods for the treatment of children with supracondylar fracture of humerus

目的比较采用闭合复位经皮外侧穿针固定和内外侧交叉穿针固定方法治疗儿童GartlandⅢ型肱骨髁上骨折的临床疗效。方法 34例GartlandⅢ型儿童肱骨髁上骨折患儿,按治疗方式不同分为外侧穿针组(18例)和交叉穿针组(16例)。外侧穿针组采用经皮外侧穿针固定治疗,交叉穿针组采用内外侧交叉穿针固定治疗。对两种手术方式的临床疗效进行对比,包括手术时间、透视次数、Flynn肘关节功能评分、骨折稳定性和医源性尺神经损伤。结果外侧穿针组手术时间、正位透视次数及侧位透视次数分别为(47.44±9.02)min、(4.28±1.02)次、(3.67±0.77)次,与交叉穿针组的(48.13±9.80)min、(4.38±0.96)次、(3.69±0.79)次比较差异无统计学意义(P>0.05)。术后3个月外侧穿针组Flynn肘关节功能与交叉穿针组比较,差异无统计学意义(P>0.05)。术后6个月外侧穿针组Flynn肘关节功能与交叉穿针组比较,差异无统计学意义(P>0.05)。外侧穿针组尺神经损伤发生率为5.56%,低于交叉穿针组的37.50%,差异有统计学意义(P<0.05)。外侧穿针组骨折再移位发生率与交叉穿针组比较,差异无统计学意义(P>0.05)。结论两种克氏针固定方法治疗儿童GartlandⅢ型肱骨髁上骨折均取得了较好的临床疗效,经皮外侧穿针固定能减少尺神经损伤并发症的发生,是增加骨折稳定性的有效方法 ,值得临床推广。

Objective To compare clinical effect of closed replacement percutaneous lateral pinning fixation and inside and outside cross pinning fixation in the treatment of children with Gartland type Ⅲ of supracondylar fracture of humerus. Methods A total of 34 children with Gartland type Ⅲ of supracondylar fracture of humerus were divided by different treatment methods into outside pinning group (18 cases) and cross pinning group (16 cases). Outside pinning group received percutaneous lateral pinning fixation treatment, andthe cross pinning group received inside and outside cross pinning fixation treatment. Comparison were made onclinical effects in two operation methods, including operation time, number of perspective, Flynn mayo elbowperformance score, fractures instability and iatrogenic ulnar nerve injury. Results The outside pinning grouphad operation time, number of normal perspective and oblique perspective respectively as (47.44±9.02) min,(4.28±1.02) times, and (3.67±0.77) times, while (48.13±9.80) min, (4.38±0.96) times and (3.69±0.79) timesin the cross pinning group. There were no statistically significant difference in two groups (P>0.05). The outsidepinning group had no statistically significant difference in Flynn mayo elbow performance score in postoperative3 months, compared with cross pinning group (P>0.05). The outside pinning group had no statistically significantdifference in Flynn mayo elbow performance score in postoperative 6 months, compared with cross pinning group(P>0.05). The outside pinning group had incidence of ulnar nerve injury as 5.56%, which was lower than 37.50%in cross pinning group, and the difference had statistical significance (P<0.05). The outside pinning group hadno statistically significant difference in incidence of fracture redisplacement compared with cross pinning group(P>0.05). Conclusion Both two kinds of gram needle fixation methods show excellent clinical effect for the treatment of children with Gartland type Ⅲ of supracondylar fracture of humerus, while percutaneous lateral pinning fixation can reduce occurrence of complications of ulnar nerve injury. As an effective method in enhancing fracture stability, it is worth clinical promotion.