微型外固定支架治疗儿童肱骨髁上骨折的病例对照研究

Case-control study on micro external fixator in treating supracondylar fracture of humerus in children

目的:探讨微型外固定支架在治疗儿童肱骨髁上骨折中的临床疗效。方法:自2017年10月至2018年12月收治20例肱骨髁上骨折患儿(治疗组),均采用闭合复位微型外固定支架固定术治疗,其中男14例,女6例;年龄6~14(7.9±2.4)岁;Gartland分型为Ⅲ型。对照组为2015年1月至2017年9月收治的39例肱骨髁上骨折患儿,采用闭合复位克氏针固定术治疗,其中男24例,女15例,年龄6~14(8.1±1.9)岁,Gartland分型为Ⅲ型。记录并比较两组患者手术时间、术中透视次数及并发症情况,末次随访均按肘关节功能Mayo评分系统评估疗效。结果:治疗组20例均得到随访,时间6~12(8.0±2.5)个月;手术时间(30.10±12.50)min,术中透视次数(10.00±2.50)次;按照Mayo评分系统,优15例,良3例,可2例,差0例;无尺神经损伤及中、重度肘内翻发生。对照组39例获得随访,时间5~13(9.0±3.1)个月;手术时间(45.60±18.90)min;术中透视次数(19.00±5.60)次;按Mayo评分系统,优23例,良12例,可3例,差1例;1例尺神经损伤末次随访时已恢复,1例发生重度肘内翻,2例中度肘内翻。两组患儿临床疗效比较差异无统计学意义(P>0.05)。治疗组中重度肘内翻发生率、手术时间、透射次数均优于对照组(P<0.05)。结论:采用闭合复位微型外固定支架固定治疗儿童肱骨髁上骨折能获得与闭合复位克氏针固定相同的临床效果,而且手术时间、术中透射次数明显减少,术中不易损伤尺神经,术后发生中重度肘内翻畸形的概率低,手术操作简单。

Objective:To explore clinical effects of micro external fixator for the treatment of supracondylar fracture of humerus in children.Methods:From October 2017 to December 2018,20 children with supracondylar fracture of humerus(treatment group)were admitted and treated with micro-external fixation after closed reduction,including 14 males and 6 females,aged from 6 to 14 years old with an average of(7.9±2.4)years old,classified to GartlandⅢ.Thirty-nine children with supracondylar fracture of humerus were admitted as control group from January 2015 to September 2017,and treated with closed reduction Kirschner wire fixation.Among them,including 24 males and 15 females,aged from 6 to 14 years old with an average of(8.1±1.9)years old,classified to GartlandⅢ.Operation time,times of intraoperative fluoroscopy,and complications between two groups were observed and compared,Mayo scoring system at the latest follow-up was used to evaluate clinical effect.Results:Twenty children in treatment group were followed up from 6 to 12 months with an average of(8.0±2.5)months,operation time was(30.10±12.50)min,times of intraoperative fluoroscopy was(10.00±2.50).Fifteen patients got excellent results,3 good,2 fair according to Mayo elbow joint scoring.No ulnar nerve injury moderate or severe elbow varus occurred in treatment group.Thirty-nine children in control group were followed up from 5 to 13 months with an average of(9.0±3.1)months,operation time was(45.60±18.90)min,times of intraoperative fluoroscopy was(19.00±5.60).Twenty-three patients got excellent results,12 good,3 fair and 1 poor according to Mayo elbow joint scoring.One child occurred ulnar nerve injury and recovered at the final follow-up,1 child occurred severe cubitus varus and 2 children occurred moderate cubitus varus.There was no statistical difference in clinical effect between two groups(P>0.05).Occurrence rate of moderate and server cubitus varus,operation time and times of intraoperative fluoroscopy in treatment group were better than that of control group(P<0.05).Conclusion:Treated with closed reduction and mini external fixator fixed on children humerus condyle fracture could receive the same clinical result as closed as reduction gram needle fixation,which has advantages of shorter operation time,less times of intraoperative fluoroscopy,not esay to damage ulnar nerve during operation,less incidence of moderate and severe cubitus varus deformity after operation,and the permeation was simple.