延误1周以上伴骨痂生成且有移位的儿童肱骨髁上骨折的治疗研究

Treatment strategy for pediatric supracondylar humeral fractures with callus formation and displacement neglected for over 1 week

目的探讨延误1周以上伴骨痂生成且有移位的儿童肱骨髁上骨折的治疗策略。方法回顾性分析2011年1月至2021年1月内蒙古医科大学第二附属医院儿童骨科医学中心收治的36例延误1周以上伴骨痂生成且有移位的儿童肱骨髁上骨折的患者资料。男22例,女14例;年龄为(6.7±2.7)岁,范围值为2.3~12.8岁;骨折均为GartlandⅢ型。根据治疗方式不同将患儿分为2组:闭合复位经皮克氏针固定(CRPP)组15例(单纯采用CRPP治疗)和杠杆组21例(经肘后克氏针撬拨"杠杆技术"辅助CRPP治疗)。比较两组患儿手术时间、透视次数、复位质量和肘关节运动范围恢复时间,末次随访时的肘关节活动度、疼痛视觉模拟评分(VAS)和Mayo肘关节功能评分(MEPS),观察并发症发生情况。结果两组患儿术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患儿术后随访(26.2±16.3)个月(范围值为6~96个月),均获可接受的复位,术后4~6周骨折临床愈合。杠杆组手术时间[(28.2±6.8)min]和透视次数[(27.0±6.0)次]均少于CRPP组[(40.8±10.8)min和(43.3±11.4)次,差异均有统计学意义(P<0.05)。与CRPP组患者术中Baumann角(78.1°±1.6°)、侧位肱头角(58.3°±2.6°)和水平旋转率(109.5%±3.0%)相比较,杠杆组(73.7°±4.1°、49.6°±5.2°、103.2%±4.9%)更优,术中复位质量更接近正常平均值,以上项目两组间比较差异均有统计学意义(P<0.05)。两组肘关节运动范围恢复时间差异无统计学意义(P>0.05)。末次随访时,杠杆组Baumann角(75.4°±2.8°)和侧位肱头角(53.2°±3.6°)均优于CRPP组(78.3°±1.5°、57.5°±2.3°),差异均有统计学意义(P<0.05)。末次随访时两组肘关节活动度、VAS评分、MEPS评分和并发症发生患者数比较差异均无统计学意义(P>0.05)。结论对延误1周以上伴骨痂生成且有移位的儿童肱骨髁上骨折患者实施经肘后克氏针撬拨"杠杆技术"辅助CRPP是一种高效、精准的治疗方法;相较于单纯CRPP,其能获得更满意的复位质量。

Objective To investigate the treatment strategy for pediatric humeral supracondylar fractures with callus formation and displacement neglected for over 1 week.Methods A retrospective analysis was made of the clinical data of 36 children who had been treated at Department of Pediatric Orthopaedics,Medical Center,The Second Affiliated Hospital,Inner Mongolia Medical University from January 2011 to January 2021 for humeral supracondylar fractures with callus formation and displacement neglected for over 1 week.There were 22 boys and 14 girls,with an age of(6.7±2.7)years(from 2.3 to 12.8 years).All fractures were Gartland typeⅢ.The patients were divided into 2 groups according to their treatment methods:a closed reduction and percutaneous pinning(CRPP)group of 15 patients subjected to the CRPP treatment only,and a leverage group of 21 patients subjected to CRPP assisted by the"lever technique"with posterior elbow Kirschner wire prying and pulling.The 2 groups were compared in terms of operation time,fluoroscopy frequency,quality of reduction,and recovery time for elbow range of motion;the elbow range of motion,visual analogue scale(VAS),Mayo elbow performance score(MEPS)and complications were assessed at the last follow-up.Results The 2 groups were comparable because there was no significant difference between them in the general information before operation(P>0.05).All patients were followed up for(26.2±16.3)months(from 6 to 96 months).All the fractures obtained acceptable reduction and clinical union 4 to 6 weeks after operation.The operation time[(28.2±6.8)min]and fluoroscopy frequency[(27.0±6.0)times]in the leverage group were significantly less than those in the CRPP group[(40.8±10.8)min and(43.3±11.4)times](P<0.05).The CRPP group was significantly better than the leverage group in the intraoperative Baumann angle(78.1°±1.6°versus 73.7°±4.1°),lateral capitellohumeral angle(58.3°±2.6°versus 49.6°±5.2°)and horizontal rotation rate(109.5%±3.0%versus 103.2%±4.9%)(P<0.05).The intraoperative reduction in the CRPP group was significantly closer to the normal mean value than that in the leverage group(P<0.05).There was no significant difference in the recovery time for elbow range of motion between the CRPP and the leverage groups(P>0.05).At the last follow-up,the Baumann angle(75.4°±2.8°)and the lateral capitellohumeral angle(53.2°±3.6°)in the leverage group were still significantly better than those in the CRPP group(78.3°±1.5°and 57.5°±2.3°)(P<0.05).However,there was no significant difference in the elbow range of motion,VAS,MEPS or incidence of complications between the 2 groups(P>0.05).Conclusion To treat humeral supracondylar fractures with callus formation and displacement neglected for over 1 week in children,CRPP assisted by the"lever technique"with posterior elbow Kirschner wire prying and pulling is an efficient and accurate method,because it can lead to more satisfactory reduction than CRPP only.