闭合复位下单纯外侧与内外侧交叉穿针固定治疗儿童伸直型肱骨髁上骨折的临床效果

Clinical effect of simple lateral and internal and external cross needle fixation under closed reduction in the treatment of children with extended supracondylar fracture of humerus

目的探讨闭合复位下单纯外侧与内外侧交叉穿针固定治疗儿童伸直型肱骨髁上骨折的临床效果。方法选择2015年8月至2018年3月我院收治的60例伸直型肱骨髁上骨折患儿作为研究对象,随机将其分为A组(30例,闭合复位下单纯外侧穿针固定治疗)与B组(30例,闭合复位下内外侧交叉穿针固定治疗)。比较两组患儿的术中相关指标、术前及术后3 d的VAS评分、术后相关并发症发生情况、术后6个月的Flynn优良率、术后6个月患侧与健侧的提携角、肘关节伸直及屈曲功能。结果 A组的手术时间明显短于B组,术中C型臂透视次数明显少于B组,差异具有统计学意义(P<0.05);两组的术中显性失血量比较,差异不具有统计学意义(P>0.05)。术后3 d,两组的VAS评分均降低,差异具有统计学意义(P<0.05);术后3 d,A组与B组的VAS评分比较,差异无统计学意义(P>0.05)。两组的术后相关并发症总发生率比较,差异无统计学意义(P>0.05)。两组患儿术后6个月的Flynn优良率比较,差异无统计学意义(P>0.05)。术后6个月,两组的患侧提携角、肘关节伸直及屈曲功能与健侧比较,差异均无统计学意义(P>0.05)。结论闭合复位下单纯外侧穿针与内外侧交叉穿针固定治疗儿童伸直型肱骨髁上骨折均具有良好的临床效果,单纯外侧穿针固定具有手术时间短、术中C臂透视次数少、术后尺神经损伤等相关并发症发生较少,手术安全性及临床实用性高的优势,值得临床推广应用。

Objective To investigate the clinical effect of simple lateral and internal and external cross needle fixation under closed reduction in the treatment of children with extended supracondylar fracture of humerus. Methods From August 2015 to March 2018, 60 children with extended supracondylar fracture of humerus admitted in our hospital were selected as the study objects and randomly divided into group A(30 cases, treated with simple lateral needling under closed reduction) and group B(30 cases, treated with internal and external cross needle fixation under closed reduction).The intraoperative indexes, VAS scores before and 3 th day after operation, postoperative complications, excellent and good rate of Flynn at 6 months after operation, the carrying angle, elbow extension and flexion function of the affected side and the healthy side at 6 months after operation were compared between the two groups. Results The operation time in the group A was significantly shorter than that in the group B, and the number of fluoroscopy of C-arm was significantly less than that in the group B, and the differences were statistically significant(P<0.05);there was no significant difference in the intraoperative dominant blood loss between the two groups(P>0.05). On the 3 th day after operation, the VAS score of the two groups decreased, and the difference was statistically significant(P<0.05);on the 3 th day after operation, there was no statistically significant difference in the VAS score between the group A and the group B(P >0.05). There was no significant difference in the total incidence of postoperative complications between the two groups(P >0.05). On the 6 months after operation, there was no significant difference in the excellent and good rate of Flynn between the two groups(P>0.05). On the 6 months after operation, there were no significant differences in the carrying angle, elbow extension and flexion function of the affected side and the healthy side between the two groups(P>0.05). Conclusion Simple lateral and internal and external cross needle fixation under closed reduction in the treatment of children with extended supracondylar fracture of humerus have good clinical effect. The simple lateral needling fixation has the advantages of short operation time, less fluoroscopy times of C-arm during operation, less postoperative ulnar nerve injury and other related complications, high safety and clinical practicability of operation, which is worthy of clinical promotion and application.