倾向性评分匹配评估内侧小切口与闭合复位内固定手术治疗小儿肱骨髁上骨折的临床效果比较

Comparison of Clinical Efficacy on Medial Small Incision and Closed Reduction and Internal Fixation in the Treatment of Supracondylar Fractures of Humerus in Children Evaluated by Propensity Score Matching

目的探讨倾向性评分匹配评估内侧小切口与闭合复位内固定手术治疗小儿肱骨髁上骨折(SHF)的价值。方法收集2018年9月至2020年9月开封市人民医院收治的76例SHF患儿临床资料,将采取内侧小切口手术治疗的SHF患儿资料纳入内侧小切口组(34例),将采取闭合复位内固定手术治疗的SHF患儿资料纳入闭合复位组(42例);应用倾向性评分配比法(1∶1,卡钳值=0.01),基于性别、年龄、发病侧等资料将两组配对,获得组间协变量均衡样本。比较两组术后6个月时的手术优良率,术前、术后6个月Baumann角及肘关节功能[肘关节Mayo功能评分(MEPS评分)]。结果倾向性评分配比前,两组Gartland骨折分型比较,差异有统计学意义(P<0.05);两组其他资料比较,差异无统计学意义(P>0.05);倾向性评分配比后,两组各32例患者纳入研究,两组基线资料比较,差异无统计学意义(P>0.05);术后6个月,两组Baumann角低于术前,且内侧小切口组低于闭合复位组,两组MEPS评分高于术前,且内侧小切口组高于闭合复位组,差异有统计学意义(P<0.05)。结论与闭合复位内固定手术比较,内侧小切口手术对小儿SHF的复位效果更佳,可有效改善患儿Baumann角,提高肘关节功能。

Objective To evaluate the value of medial small incision and closed reduction and internal fixation in the treatment of supracondylar fracture of humerus(SHF)in children evaluated by propensity score matching.Methods The clinical data of 76 children with SHF treated in Kaifeng People’s Hospital from September 2018 to September 2020 were collected,the data of SHF children treated with medial small incision were included in the medial small incision group(34 cases),the data of SHF children treated with closed reduction and internal fixation were included in the closed reduction group(42 cases);propensity score matching method was used(1∶1,caliper value=0.01),both groups were paired based on gender,age,onset side and other data,the equilibrium samples of covariates between groups were obtained.The excellent and good rate,Baumann angle and elbow function[Mayo elbow performance score(MEPS score)]before and 6 months after operation were compared between the two groups.Results Before propensity score matching,there was a statistical difference on Gartland fracture classification between the two groups(P<0.05).There was no statistical difference in comparison of other data between the two groups(P>0.05).After propensity score matching,32 patients in each group were included in the study,there was no statistical difference in comparison of other data of between the two groups(P>0.05).Six months after operation,the Baumann angle in both groups was lower than that before operation,and the medial small incision group was lower when compared with the closed reduction group,the MEPS score of both groups was higher than that before operation,and the medial small incision group was higher when compared with the closed reduction group(P<0.05).Conclusion Compared with closed reduction and internal fixation,medial small incision is more effective in the reduction of SHF in children,which can effectively improve Baumann angle and elbow function.