不同内固定方式治疗儿童尺骨鹰嘴骨折

Comparison of two internal fixation methods for treating pediatric olecranon fractures

目的通过与克氏针钢丝张力带比较,评价带尾孔针钛缆张力带治疗儿童尺骨鹰嘴骨折的临床疗效。方法回顾性分析2014年1月至2017年3月南京医科大学附属儿童医院接受手术治疗的38例尺骨鹰嘴骨折患儿临床资料。根据内植物的不同,分为二组:克氏针钢丝张力带内固定22例(克氏针组)和带尾孔针钛缆张力带内固定16例(钛缆组)。比较两组患儿的手术时间、术中出血量、骨折愈合时间、术后并发症及患肢肘关节Broberg-Morrey评分。结果38例患儿获得6~21个月随访,平均随访11.6个月。手术时间克氏针组为(56.2±12.7)min,钛缆组为(42.2±9.4)min;两组患儿取内固定前1 d行肘关节Broberg-Morrey评分,克氏针组为(80.1±15.1)分,范围55~97分,其中优9例,良9例,可3例,差1例;钛缆组为(91.4±14.3)分,范围66~99分,其中优10例,良5例,可1例,差0例。术中出血量克氏针组为(25.3±7.2)ml,钛缆组为(22.5±6.5)ml;骨折愈合时间克氏针组(8.3±3.2)周,钛缆组(8.4±2.7)周。克氏针组4例出现钢针松动、退针,2例尺骨近端出现滑囊炎。钛缆组未见内植物松动、断裂及退针。钛缆组手术时间、肘关节Broberg-Morrey评分、术后并发症明显优于克氏针组,两组比较,差异有统计学意义(P<0.05)。两组骨折患儿在术中出血量、骨折愈合时间比较,差异无统计学意义(P>0.05)。结论与克氏针张力带钢丝内固定比较,带尾孔针钛缆张力带能达到骨折牢固固定,操作简单,手术时间短,术后并发症少等优点,是儿童尺骨鹰嘴骨折一种新的治疗选择。

Objective To evaluate the therapeutic efficacy of Kirschner wire tension band fixation versus tail needle cable system fixation for pediatric olecranon fracture. Methods Respective analysis was performed for the clinical data of 38 children with olecranon fractures from January 2014 to March 2017. In group of Kirschner wire tension band fixation (n=22), there were 15 boys and 7 girls with an average age of (10.8±2.7)(8-14) years;in group of tail needle cable system fixation, there were 11 boys and 5 girls with an average age of (10.9±2.6)(8-14) years. Two groups were statistically compared in terms of operative duration, volume of intraoperative blood loss, healing time of fracture, postoperative Broberg-Morrey score of elbow and postoperative complications. ResultsAll operations were successfully completed. The average follow-up period was 11.6 (6-21) months. There was no instance of puncture wound infection or displacement of fracture fragment. Compared with Kirschner wire tension band fixation group, cable system fixation group had a significantly shorter average operative duration (42.2±9.4 vs 56.2±12.7 min) and a significantly higher average postoperative Morrey score of elbow (91.4±14.3 vs 80.1±15.1 points)(P<0.05). Based upon the Broberg-Morrey score, Kirschner wire group were excellent (n=9), good (n=9), fair (n=3) and poor (n=1) while cable group were excellent (n=10), good (n=5) and fair (n=1). There were statistical significances. The volume of blood loss of Kirschner wire group was larger than that of plate group [(25.3±4.2) vs (22.5±4.5) ml]. And fracture healing time of Kirschner wire group was less than that of cable group [(8.3±3.2) vs (8.4±2.7) weeks]. The differences were not statistically significant in fracture healing time or volume of intraoperative blood loss (P>0.05). Kirschner wire loosening or withdrawal (n=4) and proximal ulnar bursitis (n=2) occurred in Kirschner wire group. However, there was no onset of implant loosening, fracture or withdrawal in cable group. Conclusions Compared with Kirschner wire tension band fixation, tail needle cable system fixation has the advantages of simple handling, firm fixation, fewer complications and excellent functional recovery of elbow for pediatric olecranon fracture.