切开复位及闭合复位治疗肱骨髁上骨折患儿的疗效及对肘关节功能的影响

Effect of Small Incision Combined with Kirschner Wire and Manual Reductionand Plaster External Fixation in the Treatment of SupracondylarFracture of Humerus on Elbow Function in Children

目的:探究肘外侧小切口结合外侧克氏针与闭合复位结合克氏针治疗肱骨髁上骨骨折折患儿对肘关节功能的影响。方法:回顾性收集2019年7月至2020年7月我院骨科收治的74例肱骨髁上骨折患儿的临床资料,以治疗方法分为两组,肘外侧小切口结合外侧克氏针为切开组(40例),闭合复位结合克氏针记为闭合组(34例);获取两组患儿术后7周临床疗效,收集两组患儿术前、术后3周、术后5周、术后7周的肘关节功能评分(MEPS评分),并统计两组患儿术前、术后7周的肘关节旋前、旋后及屈伸活动范围。结果:闭合组住院时间、骨折愈合时间均短于切开组(P<0.05),闭合组临床优良率为97.06%,显著高于切开组的80%(P<0.05)。两组患儿术后7周内MEPS评分均随时间变化呈上升趋势,闭合组上升趋势更强。两组患儿术后7周肘关节旋前度、旋后度及屈伸度均显著升高(P<0.05);闭合组患儿术后7周及各角度差值均显著高于切开组患儿(P<0.05)。结论:肘外侧小切口结合外侧克氏针与闭合复位结合克氏针均可治疗肱骨髁上骨折,闭合复位结合克氏针可提高肱骨髁上骨折临床疗效,改善肘关节功能。

Objective:To investigate the effect of small lateral elbow incisions combined with lateral Kirschner wire and closed reduction combined with Kirschner wire on elbow joint function in children with supracondylar fracture of the humerus.Methods:Clinical data of 74 children with supracondylar fractures of the humerus admitted to the Department of Orthopedics of our hospital from July 2019 to July 2020 were retrospectively collected.They were divided into two groups based on the treatment method:a small lateral elbow incision combined with lateral Kirschner wire for the incised group(40 cases),and closed repositioning combined with Kirschner wire for the closed group(34 cases).The clinical efficacy of the two groups of children was obtained at 7 weeks postoperatively,and the elbow function scores(MEPS scores)of the two groups of children were collected before,at 3 weeks,at 5 weeks,and 7 weeks postoperatively,and the range of motion of the elbow joint before and after rotation and flexion and extension of the two groups of children were counted at 7 weeks postoperatively.Results:The hospital stay and fracture healing time of the closed group were shorter than those of the incised group(P<0.05).The clinical excellence rate in the closed group was 97.06%,significantly higher than the 80%in the incised group(P<0.05).The MEPS scores of the two groups showed an upward trend with the time change in 7 weeks after surgery,and the upward trend was stronger in the closed group.Elbow anterior rotation,posterior rotation,and flexion and extension were significantly higher in both groups at 7 weeks postoperatively(P<0.05);the difference between the closed group and each angle was significantly higher than that of the incised group at 7 weeks postoperatively(P<0.05).Conclusion:Lateral elbow incision combined with lateral Kirschner wire and closed reduction combined with Kirschner wire can treat supracondylar fracture of the humerus.Closed reduction combined with Kirschner wire can improve the clinical efficacy of supracondylar fracture of the humerus and improve elbow joint function.