关节镜辅助复位与切开复位克氏针固定治疗儿童肱骨外髁骨折的疗效比较
Arthroscopic assisted reduction versus open reduction in treatment of paediatric humeral lateral condy-lar fractures with Kirschner wire fixation
黄林 1冯超 2傅刚 1闫桂森 1杨征 1吕学敏1
作者信息
- 1. 首都医科大学附属北京积水潭医院小儿骨科,北京 100035
- 2. 首都医科大学附属北京积水潭医院小儿骨科,北京 100035;北京积水潭医院贵州医院,贵阳 550014
- 折叠
摘要
目的 比较关节镜辅助复位与切开复位克氏针固定儿童肱骨外髁骨折的疗效.方法 回顾性分析2023年8-9月于北京积水潭医院小儿骨科接受手术治疗的28例肱骨外髁骨折患儿资料.男24例,女4例;年龄(6.5±1.6)岁;骨折根据Jacob分型:Ⅱ型24例,Ⅲ型4例;骨折根据Milch分型:Ⅰ型1例,Ⅱ型27例;受伤至手术时间(71.6±21.3)h.所有患儿根据复位方式的不同分为2组:关节镜组(采用关节镜辅助复位经皮克氏针固定)16例和切开组(采用切开复位克氏针固定)12例.比较两组患儿的手术时间、切口长度、拔针时间和末次随访时Mayo肘关节功能(MEPS)评分、肘关节X线外侧骨突发生情况,末次随访时组内比较健侧与患侧肘关节屈伸活动度、提携角.结果 两组患儿术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.28例患儿术后获(4.9±0.4)个月随访.关节镜组患儿的切口长度[(1.3±0.4)cm]、拔针时间[(42.8±3.5)d]均显著短于切开组[(4.8±0.5)cm、(95.5±16.4)d],差异均有统计学意义(P＜0.05).关节镜组患儿的手术时间与切开组比较[(70.6±15.5)min vs.(61.7±14.5)min]差异无统计学意义(P＞0.05).末次随访时两组患儿健侧与患侧肘关节屈伸活动度、提携角各自组内比较差异均无统计学意义(P＞0.05).末次随访时两组患儿的MEPS评分比较差异无统计学意义(P＞0.05).末次随访时肘关节X线片结果示关节镜组外侧骨突发生患儿数与切开组比较差异无统计学意义(P＞0.05).随访期间关节镜组1例患儿出现针道感染,切开组1例患儿出现克氏针针尾外露.结论 关节镜辅助复位经皮克氏针固定治疗肱骨外髁骨折可以通过微创的方式实现骨折端清理,直观评估骨折并进行复位,相比切开复位,在减小创伤的同时没有显著增加手术时间.
Abstract
Objective To compare the clinical efficacy between arthroscopically assisted reduction versus open reduction in the treatment of paediatric humeral lateral condylar fractures with Kirschner wire fixa-tion.Methods A retrospective study was conducted to analyze the data of 28 children with humeral later-al condylar fracture who had undergone surgery at Department of Pediatric Orthopedics,Beijing Jishuitan Hos-pital from August 2023 to September 2023.There were 24 males and 4 females with an age of(6.5±1.6)years,24 cases of type Ⅱ and 4 cases of type Ⅲ fractures according to the Jacob classification,and 1 case of type Ⅰ and 27 cases of type Ⅱ fractures according to the Milch classification.The time from injury to surgery averaged(71.6±21.3)hours.The children were divided into 2 groups according to their reduction methods:an arthroscopic group of 16 cases treated by arthroscopically assisted reduction and K-wire fixation and an open reduction group of 12 cases treated by open reduction and K-wire fixation.The operation time,incision length,Kirschner wire removal time,Mayo elbow performance score(MEPS)and the incidence of lateral bony spur on the X ray at the last follow-up were compared between the 2 groups;the flexion-extension and carrying angle of the elbow were compared between the healthy side and the affected side within each group at the last follow-up.Results There was no significant difference in the preoperative general data between the 2 groups,indicating comparability(P＞0.05).The 28 pediatric patients were followed up for(4.9±0.4)months after surgery.The incision length[(1.3±0.4)cm]and Kirschner wire removal time[(42.8±3.5)d]in the arthroscopic group were significantly shorter than those in the open reduction group[(4.8±0.5)cm and(95.5±16.4)d](P＜0.05).There was no significant difference in the operation time between the 2 groups[(70.6±15.5)min versus(61.7±14.5)min](P＞0.05).There was no significant difference in the flex-ion-extension or in the carrying angle between the healthy and affected sides within each group at the last follow-up(P＞0.05).There was no significant difference either in the MEPS score or in the incidence of lateral bony spur between the 2 groups at the last follow-up(P＞0.05).Follow-up revealed pin infection in 1 patient in the arthro-scopic group,and exposure of Kirschner wire tail in 1 patient in the open reduction group.Conclusions In the treatment of humeral lateral condylar fractures,arthroscopically assisted reduction and Kirschner wire fixa-tion can allow for debridement of the fracture ends in a minimally invasive way,visual fracture evaluation and reduction.Compared with open reduction,arthroscopically assisted reduction can reduce operative trauma with-out significantly increasing operation time.
关键词
关节镜/肘关节/肱骨骨折/微创,手术Key words
Arthroscopy/Elbow/Humerus fracture/Minimal invasive,surgery引用本文复制引用
基金项目
北京市卫生健康科技成果和适宜技术推广项目(BHTPP2022016)
北京积水潭医院人才培养计划"学科新星"项目(XKXX202202)
出版年
2024
NETL
NSTL
万方数据