外固定架结合克氏针固定与克氏针固定治疗儿童肘内翻畸形疗效比较

Comparative study of external fixator combined with Kirschner wire fixation and Kirschner wires fixation in treatment of cubitus varus deformity in children

目的比较外固定架结合克氏针固定与克氏针固定治疗儿童肘内翻畸形的疗效。方法回顾分析2018年1月—2022年7月收治且符合选择标准的36例肱骨髁上骨折术后并发肘内翻畸形患儿临床资料。其中17例采用肱骨远端楔形截骨外固定架结合克氏针固定(观察组),19例采用肱骨远端楔形截骨克氏针固定(对照组)。两组患儿年龄、性别、畸形侧别、骨折至此次手术时间、健侧提携角及术前患侧提携角、肘关节屈伸活动度、外侧髁突出指数(lateral condylar prominence index,LCPI)等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患儿手术时间、住院费用、截骨愈合时间、术后并发症及末次随访时患侧提携角、LCPI和肘关节屈伸活动度;术后3个月、末次随访时采用Oppenheim评分评估肘关节功能。结果两组患儿均获随访,随访时间13~48个月,平均26.7个月。观察组和对照组分别发生1例和2例针道感染,均无神经损伤发生,两组并发症发生率(5.88%vs 10.53%)比较差异无统计学意义(χ2=0.502,P=0.593)。两组手术时间和截骨愈合时间比较差异无统计学意义(P>0.05);观察组住院费用高于对照组(P<0.05)。观察组术后3个月Oppenheim评分优于对照组(P<0.05),但末次随访时两组Oppenheim评分比较差异无统计学意义(P>0.05)。末次随访时,两组患侧提携角均较术前显著改善(P<0.05);两组间患侧提携角和肘关节屈伸活动度手术前后差值比较差异均无统计学意义(P>0.05),但观察组LCPI手术前后差值优于对照组,差异有统计学意义(P<0.05)。结论采用外固定架结合克氏针固定及单纯克氏针固定治疗儿童肘内翻畸形均可获得满意畸形矫正,而前者术后早期肘关节功能恢复更好,并可降低术后肱骨外侧髁突出的发生。

Objective To analyze the effectiveness comparison of external fixator combined with Kirschner wire fixation and Kirschner wire fixation in the treatment of cubitus varus deformity in children.Methods A retrospective case-control study was conducted to collect 36 children of postoperative supracondylar humerus fracture complicating cubitus varus deformity between January 2018 and July 2022.Among them,17 cases were treated with distal humeral wedge osteotomy external fixation combined with Kirschner wire fixation(observation group),and 19 cases were treated with distal humeral wedge osteotomy and Kirschner wire fixation(control group).The baseline data including age,gender,deformity side,time from fracture to operation,carrying angle of the healthy side and preoperative carrying angle of the affected side,elbow flexion and extension range of motion,and lateral condylar prominence index(LCPI)showed no significant difference between the two groups(P>0.05).The operation time,hospitalization cost,healing time of osteotomy,postoperative complications,and the carrying angle,LCPI,and elbow flexion and extention range of motion were recorded and compared between the two groups.The elbow function was assessed by Oppenheim score at 3 months after operation and at last follow-up.Results The children in both groups were followed up 13-48 months,with an average of 26.7 months.There was 1 case of needle tract infection in the observation group and 2 cases in the control group,and no nerve injury occurred,the difference in the incidence of complication(5.88%vs 10.53%)between the two groups was not significant(χ2=0.502,P=0.593).There was no significant difference in the operation time and fracture healing time between the two groups(P>0.05);the hospitalization cost of the observation group was significantly higher than that of the control group(P<0.05).The Oppenheim score of the observation group was significantly better than that of the control group at 3 months after operation(P<0.05),but there was no significant difference in the Oppenheim score between the two groups at last follow-up(P>0.05).At last follow-up,the carrying angle of affected side significantly improved in both groups when compared with preoperative ones(P<0.05);the differences of the pre-and post-operative carrying angle of affected side and elbow flexion and extension range of motion showed no significant differences between the two groups(P>0.05),but the difference in pre-and post-operative LCPI of the observation group was significantly better than that of the control group(P<0.05).Conclusion External fixator combined with Kirschner wire fixation and Kirschner wire fixation both can achieve satisfactory correction of cubitus varus deformity in children,and the former can achieve better short-term functional recovery of elbow joint and reduce the incidence of humeral lateral condyle protrusion.