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采用切开复位或闭合复位及经皮穿针治疗小儿移位性肱骨髁上骨折的治疗效果比较评估。

The comparative evaluation of treatment outcomes in pediatric displaced supracondylar humerus fractures managed with either open or closed reduction and percutaneous pinning.

作者信息

Keskin D, Sen H

机构信息

Department of Orthopaedics and Traumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.

出版信息

Acta Chir Orthop Traumatol Cech. 2014;81(6):380-6.

Abstract

PURPOSE OF THE STUDY

The aim of this study was to evaluate comparatively the outcomes of pediatric displaced supracondylar fractures of humerus which were treated with either closed reduction and percutaneous pinning (CRPP) or open reduction and percutaneous pinning (ORPP).

MATERIAL AND METHODS

The study included 100 children with displaced supracondylar fractures of the humerus, who were treated with either CRPP (group 1) or ORPP (group 2); the numbers of subjects in the study groups were equal. The treatment outcomes were assessed clinically and radiologically.

RESULTS

Ninety-six percent excellent or good cosmetic results were achieved in both groups, and 94% / 90% excellent or good functional results were achieved in groups 1 and 2 (respectively). There was no signifiant difference between Baumann and humero-capitellar angles of intact and operated sides in both groups, but there was an average carrying angle difference of 2,96 degrees in the group 1 and 1,52 degrees in the group 2 and these differences were statistically signifiant. Five cases (10%) from each group had superfiial pin tract infection. Hypertrophic incision scar occurred in 6 (12%) patients performed ORPP.

CONCLUSION

Both CRPP and ORPP are successful treatment methods in the management of non-complicated and non-comminuted displaced supracondylar fractures of the humerus in pediatric ages and their outcomes are similar. Incision scar and the long duration of operation are the disadvantages of open surgery. For fiing the fracture, placement of two K-wires from the medial and lateral aspects which cross each other is enough to achieve a good stability. In ORPP practices, lateral incision is a simple and reliable approach despite of the dissatisfying scar tissue formation.

摘要

研究目的

本研究旨在比较闭合复位经皮穿针(CRPP)与切开复位经皮穿针(ORPP)治疗小儿肱骨髁上移位骨折的疗效。

材料与方法

本研究纳入100例肱骨髁上移位骨折患儿,分别采用CRPP(第1组)或ORPP(第2组)治疗;两组研究对象数量相等。通过临床和影像学评估治疗效果。

结果

两组均有96%的患儿获得了优良的外观效果,第1组和第2组分别有94%/90%的患儿获得了优良的功能效果。两组患儿患侧与健侧的鲍曼角和肱骨头角均无显著差异,但第1组平均提携角差异为2.96度,第2组为1.52度,这些差异具有统计学意义。每组有5例(10%)患儿发生表浅针道感染。接受ORPP治疗的6例(12%)患儿出现切口瘢痕增生。

结论

CRPP和ORPP都是治疗小儿肱骨髁上无并发症、无粉碎性移位骨折的成功方法,且疗效相似。切口瘢痕和手术时间长是开放手术的缺点。对于骨折固定,从内外侧交叉置入两根克氏针足以获得良好的稳定性。在ORPP操作中,尽管瘢痕组织形成不尽人意,但外侧切口是一种简单可靠的入路。

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