克氏针撬拨辅助弹性髓内钉复位固定技术治疗儿童桡骨颈骨折疗效分析

Reduction and Fixation Technique of Kirschner Wire Prying Assisted Elastic Intramedullary Nailing in the Treatment of Radial Neck Fractures in Children

目的比较克氏针撬拨辅助弹性髓内钉复位固定技术与单用弹性髓内钉复位固定技术治疗儿童桡骨颈骨折的疗效。方法回顾性分析2017年1月—2019年6月该院收治的O,Brien分型为Ⅱ、Ⅲ型桡骨颈骨折患儿25例,其中单纯弹性髓内钉复位固定技术11例,设为对照组;克氏针撬拨辅助弹性髓内钉复位固定技术14例,设为观察组。观察术后3个月临床疗效、关节活动范围及手术相关并发症。结果术后3个月通过X线片评估骨折复位情况,观察组复位优率为92.9%,显著高于对照组的45.5%,差异有统计学意义(χ^2=4.716,P=0.030<0.05)。术后3个月测量两组肘关节活动范围,观察组肘关节伸、屈、旋前、旋后范围分别为(8.62±0.52)、(138.13±5.83)、(89.13±8.23)、(88.25±8.42)°,均分别显著大于对照组的(6.12±0.43)、(125.37±5.36)、(71.73±7.72)、(72.27±8.12)°,差异有统计学意义(t=4.475,P=0.032<0.05;t=3.827,P=0.041<0.05;t=3.641,P=0.044<0.05;t=3.346,P=0.048<0.05)。两组术后3个月均未发生手术相关并发症。结论经皮克氏针撬拨固定术辅助弹性髓内钉闭合复位固定技术用于儿童桡骨颈骨折治疗效果更优,术后3个月患儿肘关节活动范围更广,安全有效。

Objective To compare the efficacy of the kirschner wire-assisted elastic intramedullary nail reduction and fixation technique and the single-use elastic intramedullary nail reduction and fixation technique in the treatment of children with radial neck fracture.Methods Retrospective analysis of the O’Brien classification of children with type II and III humeral neck fractures in the hospital from January 2017 to June 2019,including 11 cases of simple elastic intramedullary nail reduction and fixation,set as a control group 14 cases of kirschner wire plucking assisted elastic intramedullary nail reduction and fixation technique were set as observation group.The clinical efficacy,range of joint activity and surgical complications were observed 3 months after surgery.Results The fracture reduction was evaluated by X-ray film 3 months after operation.The excellent and good rate of reduction in the observation group was 92.9%,which was significantly higher than that in the control group(45.5%).The difference was statistically significant(χ^2=4.716,P=0.030<0.05).The range of elbow joint motion was measured 3 months after operation.The range of elbow joint extension,flexion,pronation and supination was(8.62±0.52),(138.13±5.83),(89.13±8.23),(88.25±8.42)°,were significantly greater than the control group(6.12±0.43),(125.37±5.36),(71.73±7.72),(72.27±8.12)°,the difference was statistically significant(t=4.475,P=0.032<0.05;t=3.827,P=0.041<0.05;t=3.641,P=0.044<0.05;t=3.346,P=0.048<0.05).No surgical complications occurred in the two groups after 3 months.Conclusion Percutaneous kirschner wire fixation and assisted elastic intramedullary nail closure and reduction fixation technique is better for children with humeral neck fracture.The range of elbow joint activity is safer and more effective in 3 months after operation.It is worthy of clinical promotion.