Yuan Yue,Guan Zhiye,Sun Jun,et al.A comparative study of open reduction versus closed reduction plus percutaneous Kirschner wire fixation in the treatment of Song Ⅲ lateral humeral condylar fractures in children[J].Journal of Clinical Pediatric Surgery,2022,21(06):540-545.[doi:10.3760/cma.j.cn101785-202108034-008]
切开复位与闭合复位经皮克氏针固定治疗儿童Song Ⅲ型肱骨外髁骨折的对比研究
- Title:
- A comparative study of open reduction versus closed reduction plus percutaneous Kirschner wire fixation in the treatment of Song Ⅲ lateral humeral condylar fractures in children
- Keywords:
- Lateral Humeral Condylar Fracture; Reconstructive Surgical Procedures; Open Fracture Reduction; Closed Fracture Reduction; Fracture Fixation; Internal/MT; Treatment Outcome; Child
- 摘要:
- 目的 探讨儿童肱骨外髁骨折Song分型中Ⅲ型骨折的手术方式选择。方法 回顾性分析2017年1月至2020年8月安徽省儿童医院骨科收治的40例SongⅢ型儿童肱骨外髁骨折患儿临床资料。根据手术方式的不同分为切开复位组和闭合复位组，切开复位组采用切开复位、经皮克氏针内固定，共20例；闭合复位组采用闭合复位、经皮克氏针固定，共20例。两组术后均予石膏固定，均于术后6周、3个月、6个月、1年门诊随访，评价并记录肘关节活动度，并予X线检查评估；于术后半年及1年随访时使用Hardacre标准评估患儿临床及影像学复查结果。结果 所有患儿均于术后6周达到骨折影像学愈合标准，于门诊拔出克氏针后开始功能锻炼；6个月半年按照Hardacre标准评估，切开复位组疗效优12例，良7例，差1例；闭合复位组疗效优15例，良5例；两组疗效差异无统计学意义（P>0.05）；术后1年按照Hardacre标准评估，切开复位组疗效优15例，良4例，差1例；闭合复位组疗效均为优，两组差异有统计学意义（P<0.05）。结论 手术是SongⅢ型肱骨外髁骨折的合理选择，闭合复位经皮克氏针固定术较切开复位经皮克氏针固定术，微创无切口，且对恢复肘关节活动度，减少骨关节并发症更有优势。
- Abstract:
- Objective To explore the selection of surgical approaches for Song type Ⅲ lateral humeral condylar fractures in children.Methods From January 2017 to August 2020, clinical data were retrospectively reviewed for 40 children with lateral humeral condylar fractures.According to different operative approaches, group A underwent open reduction and percutaneous Kirschner wire internal fixation while group B closed reduction and percutaneous Kirschner wire fixation.Both groups had plaster fixation.At 6 weeks, 3 months, half a year and 1 year post-operation, range of motion of elbow joint was evaluated by radiograph.And Hardacre criteria were employed for evaluating the clinical and imaging outcomes at half a year and 1 year post-operation.Results All of them attained the standard of fracture imaging healing at 6 weeks post-operation and began functional exercises after extracting Kirschner wire at an outpatient clinic.At half a year post-operation, according to the Hardacre standard, efficacy was excellent (n=12), decent (n=7) and poor (n=1) in group A and excellent (n=15) and decent (n=5) in group B.And there was no significant inter-group difference.At 1 year post-operation, according to the Hardacre standard, efficacy was excellent (n=15), decent (n=4) and poor (n=1) in group A and excellent (n=15) and decent (n=5) in group B.And there was significant inter-group difference (P<0.05).Conclusion Surgery is ideal for Song type III lateral humeral condylar fractures.Closed reduction and percutaneous Kirschner wire fixation are not only mini-invasive without incision, but also offer more advantages in restoring range of motion of elbow joint and reducing bone and joint complications.
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备注/Memo
收稿日期:2021-08-14。
基金项目:1.安徽省卫生健康委科研项目（AHWJ2021b136）；2.安徽医科大学校科学研究基金资助项目（2020xkj254）
通讯作者:李阳,Email:totty8122@sina.com