Sun Qiang,Ye Jiajun.Clinical study of three-dimensional rotary reduction and modified rotary reduction with needle for extended ulnar deviated supracondylar humeral fractures in children with Gartland type Ⅲ/Ⅳ[J].Journal of Clinical Pediatric Surgery,2022,21(07):637-642.[doi:10.3760/cma.j.cn101785-202106037-008]
三维立体旋转整复法和改良带针旋转复位法治疗Gartland Ⅲ型和Ⅳ型儿童伸直尺偏型肱骨髁上骨折
- Title:
- Clinical study of three-dimensional rotary reduction and modified rotary reduction with needle for extended ulnar deviated supracondylar humeral fractures in children with Gartland type Ⅲ/Ⅳ
- Keywords:
- Bones and Tissues; Humeral Fractures; Reducting Luxation; Closed Fracture Reduction; Fracture Fixation; Internal
- 摘要:
- 目的 初步评估三维立体旋转整复法和改良带针旋转复位法治疗Gartland Ⅲ、Ⅳ型儿童伸直尺偏型肱骨髁上骨折的临床疗效。方法 收集四川省骨科医院儿童骨科2019年3月至2020年3月收治的130例儿童伸直尺偏型肱骨髁上骨折患者作为研究对象，其中男67例，女63例；年龄（5.8±2.9）岁；左侧62例，右侧68例；伸直尺偏外旋型106例，伸直尺偏内旋型24例；受伤至手术时间为2 h至3 d，其中急诊手术20例。骨折分型：Gartland Ⅲ型64例，Gartland Ⅳ型66例。按照整复骨折手法、置入克氏针顺序和方式不同分为三维立体旋转整复法组（n=65）和改良带针旋转复位法组（n=65）。通过数字影像学检查系统测量伤肢Baumamn角，评估术后肘关节的关节活动度（range of motion，ROM）度数、术后Baumamn角改变及丢失角度和Flynn肘关节功能评定结果。结果 所有入组患儿均顺利完成手术，均获随访，骨折均愈合。三维立体旋转整复法组手术时间为（38.03±18.17） min，改良带针旋转复位法组手术时间为（24.99±12.26） min，差异有统计学意义（P<0.05）。三维立体旋转整复法组随访时间为（14.57±2.24）个月，骨折愈合时间为（45.04±5.72） d；改良带针旋转复位法组随访时间为（14.03±2.06）个月、骨折愈合时间为（44.26±4.99） d，差异均无统计学意义（P>0.05）。后期随访中，伤肢发生肘内翻畸形共3例（其中三维立体旋转整复法组2例，分别为-6°和-5°；改良带针旋转复位法组1例，为-3°），克氏针松动2例（三维立体旋转整复法组和改良带针旋转复位法组各1例，均于术后6周拔除克氏针），伤肢发生肘内翻畸形例数比较（三维立体旋转整复法组2例，改良带针旋转复位法组1例）和克氏针松动例数比较（三维立体旋转整复法组1例，改良带针旋转复位法1例）差异均无统计学意义（P>0.05）；针道感染1例（为三维立体旋转整复法组患儿，出现于术后2周，予加强换药、外擦莫匹罗星软膏后治愈），改良带针旋转复位法组无一例针道感染，差异有统计学意义（P<0.01）。两组均无一例骨筋膜间室综合征、医源性血管神经损伤、Volkmann挛缩和骨化性肌炎。术后3个月，三维立体旋转整复法组肘关节ROM角度，屈肘角度为（136.01±4.26）°、伸肘角度为（7.04±2.11）°、过伸角度为（6.11±3.67）°；改良带针旋转复位法组肘关节ROM角度，屈肘角度为（141.90±3.76）°、伸肘角度为（4.90±2.78）°、过伸角度为（3.27±2.27）°；两组伤肢肘关节ROM度数比较，差异有统计学意义（P<0.05）。三维立体旋转整复法组术后即刻Baumamn角为（72.0±6.5）°，改良带针旋转复位法组术后即刻Baumamn角为（74.5±7.0）°，差异无统计学意义（P>0.05）。三维立体旋转整复法组术后12个月及以上（末次随访） Baumamn角丢失角度为（3.86±1.07）°，改良带针旋转复位法组术后12个月及以上（末次随访） Baumamn角丢失角度为（3.58±1.12）°，差异无统计学意义（P>0.05）。术后12个月，两组Flynn肘关节功能比较，三维立体旋转整复法组中优53例、良5例、可5例、差2例；改良带针旋转复位法组中优60例、良3例、可1例、差1例，差异有统计学意义（P<0.05）。结论 改良带针旋转复位法较三维立体旋转整复法治疗Gartland Ⅲ、Ⅳ型儿童伸直尺偏型肱骨髁上骨折手术时间更短，后期肘关节屈伸功能和提携角外观恢复均更好，值得临床推广应用。
- Abstract:
- Objective To evaluate the clinical efficacy of three-dimensional rotary reduction versus modified rotary reduction with needle for children with extended ulnar deviation supracondylar humeral fractures in Gartland Ⅲ/Ⅳ. Methods From March 2019 to March 2020, 130 children with extended ulnar supracondylar humeral fracture were recruited.There were 67 boys and 63 girls with an age range of (5.8±2.9) years.The involved side was left (n=62) and right (n=68).There were straight ruler with outward rotation (n=106) and straight ruler with inward rotation (n=24).Time from injury to operation ranged from 2h to 3d and emergency operation (n=20) was performed.Fracture types were Gartland Ⅲ (n=64) and Gartland Ⅳ (n=66).According to different methods of fracture repair, order and method of placing Kirschner wire, they were divided into two groups of three dimensional rotary reduction (n=65) and improved rotary reduction with needle (n=65).Baumamn Angle of injured extremity was measured by digital imaging examination system and postoperative ROM (range of motion) degree of elbow, postoperative Baumamn angle change, loss angle and Flynn’s elbow function were evaluated.Results All fractures healed during follow-ups.Statistically significant inter-group difference existed in operative duration (P<0.05).However, no statistically significant difference existed in follow-up time, fracture healing time, cubitus varus deformity or Kirschner wire loosening (P>0.05).And statistically significant inter-group difference existed in postoperative needle infection (P<0.01).At Month 3 post-operation, ROM of injured elbow was compared and the inter-group difference was statistically significant (P<0.05).No significant inter-group difference existed in Baumamn angle immediately after extremity injury (P>0.05).No inter-group significant difference existed in Baumamn angle loss at Month 12 after extremity injury (the last follow-up) (P>0.05).At Month 12 post-operation, Flynn’s elbow function was compared and the inter-group difference was statistically significant (P<0.05).There was no onset of compartment syndrome, Kirschner wire rupture/rejection, iatrogenic vascular nerve injury, Volkmann’s contracture or myositis ossificans. Conclusion As compared with three-dimensional rotary reduction, for Gartland Ⅲ/Ⅳ children with straight ulnar partial humeral supracondylar fracture, modified rotary reduction offers the advantages of shorter operative duration, better recovery of elbow flexion/extension and appearance of lifting angle.A wider popularization is worthwhile.
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备注/Memo
收稿日期:2021-06-14。
基金项目:四川省中医药管理局基金课题（2020LC0181）
通讯作者:孙强,Email:2357401669@qq.com