摘要
目的 探讨可吸收带线锚钉及克氏针在治疗O'Driscoll Ⅰ、Ⅱ型冠状突骨折时的临床效果.方法 回顾性分析2017年1月-2021年1月医院骨科收治的46例O'Driscoll Ⅰ、Ⅱ型冠状突骨折患者病例资料,根据手术方式分为可吸收带线锚钉固定(锚钉固定组)和克氏针固定(克氏针固定组),每组各23例.比较两组患者手术时间、首次自主活动时间、术后并发症及肘关节活动度,并通过Mayo肘关节功能评分标准(Mayo elbow performance score,MEPS)评价临床效果.结果 46例均获得满意随访.手术时间比较锚钉组(119.00±5.82)min,克氏针组(110.47±11.38)min,差异无统计学意义(P＞0.05);首次自主活动时间锚钉组12～16d,平均(13.78±1.53)d,早于克氏针组18～21 d,平均(19.78±0.95)d,差异有统计学意义(P＜0.05);末次随访时两组肘关节屈曲活动度锚钉组104°～137°,平均(121.91±8.99)°,克氏针组95°～108°,平均(101.95±4.38)°,差异有统计学意义(P＜0.05);前臂旋转度锚钉组122°～140°,平均(130.34±5.40)°,克氏针组 90°～128°,平均(103.21±6.06)°,差异有统计学意义(P＜0.05);MEPS 标准评定,锚钉组:优19例,良2例,可2例,优良率91.3％,高于克氏针组:优9例,良5例,可9例,优良率60.9％,差异具有统计学意义(P＜0.05).结论 可吸收带线锚钉套索固定是治疗O'Driscoll Ⅰ、Ⅱ型冠状突骨折的有效方法,手术创伤小,固定牢靠,操作简单,可早期行功能训练,值得推广应用.
Abstract
Objective To investigate the clinical effect of suture anchor and Kirschner wires on the treatment of O'Driscoll type Ⅰ and Ⅱ coronoid fractures.Methods The clinical data of patients with O'Driscoll type Ⅰ and Ⅱ coronary fractures admitted from January 2017 to January 2021 were retrospectively analyzed,and the patients were divided into absorbable wire anchor fixation(anchor fixation group)and Kirschner pin fixation(Kirschner pin fixation group)according to the surgical methods.In this study,46 patients with O'Driscoll type Ⅰ and Ⅱ coronary fractures were included,including 23 patients(20 males and 3 females)in the anchoring group and 13 males and 10 females in the Kirschner pin group.The operative time,first time of voluntary movement,postoperative complications and elbow motion were compared between two groups,and the clinical effect was evaluated by elbow Mayo score(MEPS).Results All 46 patients received satisfactory follow-up visits,and the operation time of two groups[anchor group(119±5.82)min Bicker's needle group(110.47±11.38)min]was statistically significant(P＜0.05).The first time of spontaneous movement[anchor group 12～16(13.78±1.53)d]and Bicker's needle group 18～21(19.78±0.95)d],the difference was statistically significant(P＜0.05);the elbow flexural motion of two groups at the last follow-up[anchor group:104°～137°(121.91±8.99)°Bic needle group 95°～108°(101.95±4.38)°]had statistical significance(P＜0.05);forearm rotation[anchor pin group:122°～140°(130.34±5.40)°Bic needle group 90°～128°(103.21±6.06)°]there was statistical significance(P＜0.05).The MEPS scores in the anchor nail group were excellent in 19 cases,good in 2 cases and fair in 2 cases,and the excellent and good rate(91.3％)was higher than that in the Kirschner pin group:excellent in 9 cases,good in 5 cases and fair in 9 cases,and the excellent and good rate(60.9％),with statistical difference(P＜0.05).Conclusion Both suture anchor and Kirschner wires are effective methods for the treatment of O'Driscoll type Ⅰ and Ⅱ coronoid fractures.However,the surgical method with suture anchor has clear surgical field,less surgical trauma,stable fixation,simple operation,and early functional exercise,which is worthy of promotion and application.
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