切开复位与闭合复位经皮克氏针内固定治疗小儿肱骨髁上骨折的疗效比较

Comparison effect of open reduction and closed reduction with percutaneous Kirschner wire internal fixation for the treatment of humeral supracondylar fractures in children

目的比较切开复位与闭合复位经皮克氏针内固定治疗小儿肱骨髁上骨折的疗效。方法将58例肱骨髁上骨折患儿按照随机数字表法分为对照组(采用切开复位经皮克氏针内固定治疗,29例)和观察组(采用闭合复位经皮克氏针内固定治疗,29例)。比较两组切口长度、术中出血量、手术时间、骨痂形成时间、骨折愈合时间、肘关节功能恢复情况、并发症发生情况。结果患儿均获得随访,时间6~12个月。切口长度、术中出血量、手术时间观察组均短(少)于对照组,差异均有统计学意义(P<0.01)。骨痂形成时间、骨折愈合时间、术后并发症发生率两组比较差异均无统计学意义(P>0.05)。末次随访采用Flynn评分评价的肘关节功能恢复优良率两组比较差异无统计学意义(P>0.05)。结论切开复位与闭合复位经皮克氏针内固定治疗小儿肱骨髁上骨折临床疗效均满意,但闭合复位有手术切口较短、术中出血量少、手术时间短的优势。

Objective To compare the efficacy of open reduction and closed reduction with percutaneous Kirschner wire internal fixation in the treatment of humeral supracondylar fractures in children.Methods The 58 children with humeral supracondylar fractures were randomly divided into a control group(29 cases were treated with open reduction and percutaneous Kirschner wire internal fixation)and an observation group(29 cases were treated with closed reduction and percutaneous Kirschner wire internal fixation).The incision length,intraoperative bleeding volume,surgical time,callus formation time,fracture healing time,recovery of elbow joint function and incidence of complications were compared between the two groups.Results All patients were followed up for 6~12 months.The incision length,intraoperative bleeding volume and surgical time in the observation group were shorter(less)than those in the control group,and the differences were all statistically significant(P<0.01).There were no statistically significant differences between the two groups in terms of callus formation time,fracture healing time,and postoperative complication incidence rate(P>0.05).At the last follow-up,there was no statistical difference in the excellent-good rate of elbow joint function recovery evaluated with Flynn scores between the two groups(P>0.05).Conclusions The clinical effects are both satisfactory for open reduction and closed reduction with percutaneous Kirschner wire internal fixation for treatment of humeral supracondylar fracture in children,but closed reduction has the advantages of shorter surgical incision,less intraoperative bleeding volume and shorter operation time.