儿童伸直型肱骨髁上骨折治疗后肘内翻畸形的危险因素分析

Risk factors of cubitus varus in extension type supracondylar humeral fracture in children

目的探讨儿童伸直型肱骨髁上骨折治疗后出现肘内翻畸形的危险因素。方法回顾性病例对照研究。纳入2017年9月—2020年8月南京医科大学附属儿童医院骨科630例伸直型肱骨髁上骨折患儿的临床资料。其中,男458例,女172例;年龄1~14(8.4±2.7)岁;肘内翻35例,非肘内翻595例。观察指标:(1)影响肘内翻畸形的危险因素的单因素分析(包括性别、年龄、体质量指数、骨折Gartland分型、骨折远端移位方向、是否合并旋转移位、治疗方式以及骨折至功能锻炼的时间)。(2)多因素logistic回归模型分析发生肘内翻畸形的独立危险因素。结果单因素分析显示,骨折移位方向是肘内翻的危险因素(χ^(2)=73.13,P<0.001)。进一步多因素logistic回归分析显示,尺偏移位为发生肘内翻畸形的独立危险因素(比值比19.54,95%可信区间5.748~66.423,P<0.001)。结论骨折远端尺偏移位是儿童伸直型肱骨髁上骨折出现肘内翻畸形的独立危险因素。

Objective This study aimed to investigate the risk factors of cubit varus deformity after treatment of txtension type supracondylar humeral fracture in children.Methods This was a retrospective case control study.Clinical data of 630 children with txtension type humeral supracondylar fracture admitted at the Department of Orthopedic Surgery,Children's Hospital of Nanjing Medical University,from September 2017 to August 2020 were included in this study,including 458 males and 172 females aged 1-14(8.4±2.7)years.Among them,35 were cubital varus cases and 595 were non-cubital varus cases.For outcome measures:(1)Univariate analysis of risk factors for cubitus varus deformity(include gender,age,body mass index,Gartland type of fracture,direction of distal fracture displacement,whether combined with rotational displacement,treatment method,and time from fracture to functional exercise)was conducted.(2)Multivariate logistic regression model was used to analyze the independent risk factors for cubital varus deformity.Results Univariate analysis showed that the direction of fracture displacement was a risk factor for cubital varus(χ^(2)=73.13,P<0.001).Further multivariate logistic regression analysis showed that ulnar deviation was an independent risk factor for cubital varus(odds ratio:19.54,95%confidence interval:5.748-66.423,P<0.001).Conclusion Distal ulnar deviation is an independent risk factor for cubitus varus in children with txtension type supracondylar humeral fracture.