65例儿童髁突囊内骨折保守治疗临床预后的Helkimo指数评价

Evaluation of clinical prognosis of condylar intracapsular fractures in 65 children with conservative treatment using Helkimo index

目的:应用Helkimo指数对行保守治疗的儿童髁突囊内骨折病例的临床预后进行回顾分析,探讨年龄、单侧或双侧骨折、骨折类型及治疗方法等因素对临床预后的影响。方法:对2009年8月—2019年8月65例(96侧)行保守治疗的儿童髁突囊内骨折患者的临床预后情况进行回顾,采用Helkimo指数(包括Ai指数和Di指数)作为评估工具,根据年龄、单侧或双侧骨折、骨折类型及保守治疗方法分亚组进行比较,采用SPSS 25.0软件包对数据进行非参数检验。结果:60例患者(92.31%)无明显主观症状(Ai 0和Ai I),52例患者(80%)功能正常或有轻度功能障碍(Di 0和Di I)。不同年龄组间Ai指数的差异有统计学意义(P=0.001);相比12~16岁组,0~5岁组(P<0.05)、6~11岁组(P<0.05)的Ai指数较小,主观临床预后更佳,但年龄对Di指数无显著影响(P=0.144)。单侧或双侧骨折(P=0.178)、不同骨折类型(P=0.139)、不同治疗方法(P=0.121)之间Ai指数无显著差异;单侧或双侧骨折(P=0.321)、不同骨折类型(P=0.692)、不同治疗方法(P=0.944)之间Di指数也无统计学差异。结论:儿童髁突囊内骨折经保守治疗的临床预后整体良好,主诉症状改善理想,部分患儿存在轻度功能障碍。

PURPOSE: To evaluate the clinical prognosis of conservative treatment in children with condylar intracapsular fractures and explore different influencial factors including age, fracture type and treatment methods on the clinical prognosis. METHODS: A retrospective study was conducted in 65 children(96 sides) with condylar intracapsular fractures treated with conservative treatment from August 2009 to August 2019. The clinical prognosis assessed by Helkimo index(including Ai index and Di index) was analyzed, and compared respectively among different age group,fracture type and treatment methods. Non-parametric test was performed using SPSS 25.0 software package. RESULTS:Sixty patients(92.31%) had no obvious subjective symptoms(Ai 0 and Ai I), and 52 patients(80%) had normal clinical function or mild dysfunction(Di 0 and Di I). The differences in Ai levels between different age groups were statistically significant(P=0.001). Compared with 12-16 year old group, 0-5 year old group(P<0.05) and 6-11 year old group(P<0.05)both had better subjective clinical prognosis with smaller Ai index whereas age had no significant impact on Di index.There was no significant difference in Ai index between unilateral and bilateral fractures(P=0.178), different fracture types(P =0.139) and conservative treatment methods(P =0.121). Similarly, no significant difference was found in Di index between unilateral and bilateral fractures(P=0.321), different fracture types(P=0.692) and conservative treatment methods(P=0.944). CONCLUSIONS: Through conservative treatment, the clinical prognosis of condylar intracapsular fractures in children is proved to be good overall. The complaint of patients improves well though part of patients have mild dysfunction.