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微型外固定架治疗儿童肱骨髁上骨折的病例对照研究

[Case control study on micro external fixator in treating supracondylar fracture of humerus in children].

作者信息

Xu Yi-Wen, Zheng Yong, Shi Zhen, Cheng Hao, Jiao Zhi-Jian, Cao Wei, Zheng Bo, Ruan Bi-Gang

机构信息

Department of Orthopaedics, Central Hospital of Xianning, Xianning 437000, Hubei, China.

出版信息

Zhongguo Gu Shang. 2020 Oct 25;33(10):902-6. doi: 10.12200/j.issn.1003-0034.2020.10.003.

Abstract

OBJECTIVE

To explore clinical effects of micro external fixator for the treatment of supracondylar fracture of humerus in children.

METHODS

From October 2017 to December 2018, 20 children with supracondylar fracture of humerus (treatment group) were admitted and treated with micro-external fixation after closed reduction, including 14 males and 6 females, aged from 6 to 14 years old with an average of (7.9±2.4) years old, classified to Gartland Ⅲ. Thirty nine children with supracondylar fracture of humerus were admitted as control group from January 2015 to September 2017, and treated with closed reduction Kirschner wire fixation. Among them, including 24 males and 15 females, aged from 6 to 14 years old with an average of (8.1±1.9) years old, classified to GartlandⅢ. Operation time, times of intraoperative fluoroscopy, and complications between two groups were observed and compared, Mayo scoring system at the latest follow up was used to evaluate clinical effect.

RESULTS

Twenty children in treatment group were followed up from 6 to 12 months with an average of (8.0±2.5) months, operation time was(30.10±12.50) min, times of intraoperative fluoroscopy was(10.00±2.50). Fifteen patients got excellent results, 3 good, 2 fair according to Mayo elbow joint scoring. No ulnar nerve injury moderate or severe elbow varus occurred in treatment group. Thirty-nine children in control group were followed up from 5 to 13 months with an average of (9.0±3.1) months, operation time was(45.60±18.90) min, times of intraoperative fluoroscopy was(19.00±5.60). Twenty-three patients got excellent results, 12 good, 3 fair and 1 poor according to Mayo elbow joint scoring. One child occurred ulnar nerve injury and recovered at the final follow-up, 1 child occurred severe cubitus varus and 2 children occurred moderate cubitus varus. There was no statistical difference in clinical effect between two groups (>0.05). Occurrence rate of moderate and server cubitus varus, operation time and times of intraoperative fluoroscopy in treatment group were better than that of control group(<0.05).

CONCLUSION

Treated with closedreduction and mini external fixator fixed on children humerus condyle fracture could receive the same clinical result as closed as reduction gram needle fixation, which has advantages of shorter operation time, less times of intraoperative fluoroscopy, not esay to damage ulnar nerve during operation, less incidence of moderate and severe cubitus varus deformity after operation, and the permeation was simple.

摘要

目的

探讨微型外固定架治疗儿童肱骨髁上骨折的临床效果。

方法

选取2017年10月至2018年12月收治的20例肱骨髁上骨折患儿(治疗组),均行闭合复位后采用微型外固定架治疗,其中男14例,女6例,年龄6~14岁,平均(7.9±2.4)岁,GartlandⅢ型。选取2015年1月至2017年9月收治的39例肱骨髁上骨折患儿作为对照组,采用闭合复位克氏针内固定治疗,其中男24例,女15例,年龄6~14岁,平均(8.1±1.9)岁,GartlandⅢ型。观察比较两组手术时间、术中透视次数及并发症发生情况,末次随访时采用Mayo评分系统评价临床疗效。

结果

治疗组20例患儿随访6~12个月,平均(8.0±2.5)个月,手术时间为(30.10±12.50)min,术中透视次数为(10.00±2.50)次。根据Mayo肘关节评分,优15例,良3例,可2例。治疗组无尺神经损伤及中重度肘内翻发生。对照组39例患儿随访5~13个月,平均(9.0±3.1)个月,手术时间为(45.60±18.90)min,术中透视次数为(19.00±5.60)次。根据Mayo肘关节评分,优23例,良12例,可3例,差1例。1例患儿发生尺神经损伤,末次随访时恢复;1例患儿发生重度肘内翻,2例患儿发生中度肘内翻。两组临床疗效比较差异无统计学意义(P>0.05)。治疗组中重度肘内翻发生率、手术时间及术中透视次数均优于对照组(P<0.05)。

结论

闭合复位微型外固定架治疗儿童肱骨髁上骨折与闭合复位克氏针内固定临床效果相当,具有手术时间短、术中透视次数少、术中不易损伤尺神经、术后中重度肘内翻畸形发生率低及操作简便等优点。

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