Sun Liang,Cui Xiaolong,Liu Wanlin,et al.Clinical results of ultra-early plaster removal after percutaneous needle fixation for supracondylar humeral fractures in children[J].Journal of Clinical Pediatric Surgery,2023,22(10):982-987.[doi:10.3760/cma.j.cn101785-202103020-015]
儿童肱骨髁上骨折经皮穿针固定术后超早期拆除石膏的临床效果分析
- Title:
- Clinical results of ultra-early plaster removal after percutaneous needle fixation for supracondylar humeral fractures in children
- Keywords:
- Supracondylar Humeral Fracture; Closed Fracture Reduction; Fracture Fixation; Internal; Casts; Surgical; Treatment Outcome; Comparative Study
- 摘要:
- 目的 探讨儿童伸直型肱骨髁上骨折经皮穿针固定术后超早期(术后2周)拆除石膏外固定的安全性与有效性。方法 采用前瞻性研究方法,收集2018年1月至2020年12月内蒙古医科大学第二附属医院小儿骨科收治的100例Gartland Ⅱ和Ⅲ型儿童伸直型肱骨髁上骨折患儿作为研究对象,其中88例符合纳入标准,男52例、女33例,均于伤后早期行闭合复位经皮克氏针内固定术。遵循随机化原则分为观察组(n=43)和对照组(n=45)。观察组于术后2周拆除石膏外固定,术后4周拔出克氏针;对照组于术后4周拆除石膏外固定,术后6~8周拔出克氏针。两组均于术后即刻及术后12周行X线检查。评估内容包括:术后即刻及术后12周患侧肘关节Baumann角、提携角、肱头角、术后6周及12周患侧肘关节活动度(与健侧比较),并于末次随访时采用Flynn评分标准评定肘关节功能优良率。比较两组Baumann角、提携角、肱头角、肘关节活动度、Flynn评分标准,评定肘关节功能优良率及术后骨筋膜室综合征、针道感染等并发症情况。两组患儿均至少随访至术后12周。结果 两组均于术后4~8周达到骨折临床愈合标准。术后6周时患侧肘关节平均活动受限度:观察组为(3.09±1.38)°,对照组为(15.91±3.26)°,差异有统计学意义(P＜0.05)。两组术后12周末次随访时,患侧肘关节平均活动受限度均＜5°,其中观察组为(0.95±0.95)°,对照组为(1.02±0.87)°,差异无统计学意义(P＞0.05)。两组术后即刻与术后12周患侧肘关节Baumann角、提携角及肱头角比较,差异均无统计学意义(P＞0.05),观察组无一例因超早期拆除石膏而导致复位角度丢失。末次随访时按照Flynn评分标准,两组肘关节功能优良率相似,差异无统计学意义(P＞0.05)。两组均无一例发生骨筋膜室综合征。观察组无一例发生针道感染,对照组发生4例,经拔除克氏针后口服抗生素治愈。结论 儿童Gartland Ⅱ、Ⅲ型伸直型肱骨髁上骨折接受经皮克氏针内固定术后,采取超早期(术后2周)拆除石膏不会导致复位角度丢失而增加再次手术风险,术后6周患侧肘关节功能基本恢复正常,肘关节康复时间明显缩短,针道感染发生率低。但本研究纳入的病例数较少,其临床安全性与有效性还需更高等级的随机对照研究进一步证实。
- Abstract:
- Objective To explore the clinical safety and efficacy of ultra-early removal of external plaster fixation (2 weeks post-operation) after percutaneous needle fixation for supracondylar humeral fracture in children.Methods A prospective analysis was conducted for 100 Gartland Ⅱ/Ⅲ children with extended supracondylar humeral fractures from January 2018 to December 2020.A total of 88 children fulfilled the inclusion criteria,including 52 boys and 33 girls.All of them underwent closed reduction and percutaneous internal fixation.They were randomized into two groups of observation (n=43) and control (n=45).In observation group,plaster external fixation was removed at Week 2 and Kirschner wire at Week 4 post-operation.In control group,plaster external fixation was removed at Week 4 post-operation and Kirschner wire at Week 6-8 post-operation.Both groups received radiograph examination immediately and at Week 12 post-operation.Clinical assessments included Baumann,carrying and capitellohumeral angles immediately and at Week 12 post-operation.Range of motion of affected elbow was assessed at Week 6/12 (versus healthy side).The good/excellent rate of elbow function was assessed by the Flynn score at the last follow-up.T,Chi-square and Fisher’s exact tests were employed for comparing Baumann angle,carrying angle,capitellohumeral angle,range of motion of elbow and Flynn score to evaluate the outcomes of elbow function,the occurrence of postoperative compartment syndrome and infection rate.The postoperative follow-up period was at least 12 weeks.Results All fractures reached clinical healing standards at Week 4-8 post-operation.At Week 6 post-operation,mean mobility limit of elbow joint was (3.09±1.38)°in observation group and (15.91±3.26)°in control group and the difference was statistically significant (P<0.05).At Week 12 post-operation,mean limit of elbow movement was <5°in both groups.Observation group was (0.95±0.95)?nd control group (1.02±0.87)°without statistical significance (P＞0.05).No significant inter-group differences existed in Baumann,carrying and capitellohumeral angles of affected elbow immediately after surgery and at Week 12 post-operation (P＞0.05).No reduction angle was lost in observation group due to ultra-early plaster removal.According to Flynn score at the last follow-up,good/excellent rates of elbow joint function were similar between two groups without statistical significance (P＞0.05).There was no compartment syndrome in neither groups.There was no needle infection in observation group while 4 cases of needle infection in control group were cured by oral antibiotics after removing Kirschner wire.Conclusion After percutaneous needle internal fixation for Gartland Ⅱ/Ⅲ supracondylar humeral fractures in children,ultra-early removal of cast (2 weeks post-operation) will not lead to a loss of reduction angle or increase the risk of reoperation.Elbow function of affected side basically normalizes at Week 6 post-operation and recovery time of elbow becomes significantly shortened.The incidence of needle tract infection is low.However,the sample size of this study is too small.Its clinical safety and efficacy should be confirmed by a larger randomized controlled trial.
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备注/Memo
收稿日期:2021-3-11。
通讯作者:白锐,Email:bairuiandaiqing@126.com