两种内固定治疗儿童12周内肱骨外髁陈旧骨折的疗效比较

Efficacy comparison of two kinds of methods for treatment of old fracture of humeral lateral condyle in clildren within 12 weeks

目的比较克氏针内固定和空心加压螺钉联合克氏针内固定治疗儿童12周内肱骨外髁陈旧骨折的临床疗效。方法将81例伤后12周内的肱骨外髁陈旧骨折患儿根据内固定方法不同分为克氏针组(48例,采用外侧入路2~3枚克氏针内固定治疗)和空心钉组(33例,采用外侧入路1枚空心加压螺钉联合1枚横向克氏针内固定治疗)。比较两组手术时间、骨折愈合时间、Baumann角、提携角、肘关节Dhillon评分、肘关节活动度以及并发症发生率。结果患儿均获得随访,时间2~5(3.44±0.89)年。手术时间及骨折愈合时间两组比较差异均无统计学意义(P>0.05)。末次随访时,Baumann角、提携角、肘关节Dhillon评分以及肘关节各项活动度两组比较差异均无统计学意义(P>0.05)。克氏针组3例(6.25%)、空心钉组8例(24.24%)发生术后短期并发症,术后并发症发生率空心钉组高于克氏针组(P<0.05)。结论克氏针内固定和空心加压螺钉联合克氏针内固定治疗儿童12周内肱骨外髁陈旧骨折均可获得满意效果,但克氏针内固定术后短期并发症少,且无需二次手术。

Objective To compare the clinical effect of Kirschner wire internal fixation and cannulated compression screw combined with Kirschner wire internal fixation in the treatment of old fracture of humeral lateral condyle in children within 12 weeks.Methods The 81 children with old fractures of humeral lateral condyle within 12 weeks after trauma were divided into two groups according to different internal fixation methods:Kirschner wire group(48 cases were treated with 2~3 Kirschner wires via lateral approach)and cannulated screw group(33 cases were treated with 1 cannulated compression screw and 1 transverse Kirschner wire with lateral approach).The operation time,fracture healing time,Baumann angle,lifting angle,Dhillon score of elbow joint,elbow joint range of motion and complication incidence rate were compared between the two groups.Results All patients were followed up for 2~5(3.44±0.89)years.There were no significant differences in the operation time and fracture healing time between the two groups(P>0.05).At the last follow-up,there was no significant difference between the two groups in Baumann angle,lifting angle,Dhillon score and various range of motion of the elbow joint(P>0.05).Short-term postoperative complications occurred in 3 cases(6.25%)of the Kirschner wire group and 8 cases(24.24%)in the cannulated screw group;the incidence rate of postoperative complications in the cannulated screw group was higher than that in the Kirschner wire group(P<0.05).Conclusions In the treatment of old fracture of humeral lateral condyle in children within 12 weeks,both Kirschner wire internal fixation and cannulated compression screw combined with Kirschner wire internal fixation can achieve satisfactory results,but Kirschner wire internal fixation has few complications in the short term,without of secondary operation.