“半无菌”技术在儿童Gartland Ⅱ型肱骨髁上骨折手术中的应用

Application of "semi-sterile" technique in the surgery of Gartland Ⅱ supracondylar humerus fractures in children

目的 探讨“半无菌”技术在儿童GartlandⅡ型肱骨髁上骨折手术中的应用价值。方法 回顾性分析2015年1月至2020年1月收治的行闭合复位经皮克氏针固定术的GartlandⅡ型肱骨髁上骨折患儿82例。其中35例采用“半无菌”方式进行手术的患儿设为“半无菌”组,而采用传统消毒铺巾方式进行手术的47例患儿设为对照组。比较两组患儿术前准备时间、手术时间、总住院时间、住院费用、术后并发症及肘关节Flynn’s评分的差异。结果 与对照组相比,“半无菌”组患儿的手术准备时间[(7.17±1.67)mim vs (9.53±1.82)min]、手术费用[(7 543.14±168.64)元vs (8 537.66±109.21)元]均显著降低,差异有统计学意义(P<0.05)。两组均未出现钉道感染及深部感染、医源性副损伤、骨折二次移位及关节畸形等并发症,肘关节功能良好。结论 对GartlandⅡ型儿童肱骨髁上骨折进行闭合复位经皮克氏针固定疗效令人满意,在手术中使用“半无菌”技术安全、有效,能够显著缩短手术准备时间,节约医疗资源,减低医疗费用。

Objective To study the application value of "semi-sterile" technique in children’s Gartland Ⅱ supracondylar fracture of the humerus. Methods A retrospective analysis of 82 children with Gartland Ⅱsupracondylar fracture of the humerus, who underwent closed reduction and percutaneous Kirschner wire fixation from January 2015 to January 2020, was performed. Among them, 35 patients were operated in a "semi-sterile" method and 47 children who were operated using traditional sterile drape were set as the control group. The differences in preoperative preparation time, operation time, total hospitalization time, hospital expenses, postoperative complications, and Flynn’s score of the elbow joint between the two groups were compared. Results Compared with the control group, the surgical preparation time of children in the "semi-sterile" group [(7.17±1.67)min vs(9.53±1.82)min] and the operation cost [(7 543.14±168.64) yuan vs(8 537.66±109.21) yuan] were significantly reduced, and the difference was statistically significant(P<0.05). There were no complications such as nail tract infection and deep infection, iatrogenic secondary injury, secondary fracture displacement and joint deformity, and the elbow joint function was good(Flynn’s score). Conclusion The effect of closed reduction and percutaneous Kirschner wire fixation for children with Gartland type Ⅱ humeral supracondylar fractures is satisfactory. The use of "semi-sterile" technology in surgery is safe and effective, which can significantly shorten the preparation time for surgery, save medical resources, and reduce medical expenses. It is worth to advocate the wide application of this technique during the operation of Gartland type Ⅱ fractures.