外侧穿针与“Slongo's”外固定架两种术式在大龄儿童肱骨髁上骨折手术治疗中的疗效比较

Comparison of therapeutic effect of lateral entry pinning and “Slongo's” external fixator in the surgical treatment of supracondylar humeral fractures in older children

关键词:  肱骨髁上骨折  大龄儿童  克氏针  外固定架

Key words:  supracondylar humeral fracture  older children  Kirschner wire  external fixator

摘要:

目的 比较外侧克氏针与"Slongo's"外固定架两种术式在大龄儿童肱骨髁上骨折手术治疗中的疗效。方法 回顾性分析2016年1月至2020年12月本院收治手术的>8岁的伸直型儿童肱骨髁上骨折患儿52例，其中一组患儿采用外侧克氏针内固定手术治疗，另一组采用"Slongo's"外固定架手术治疗。比较两组患儿基本情况，同时进行术后复查随访评价肘关节功能，观察患儿并发症情况。结果 与外固定架组相比，克氏针组住院及手术时间较短，透视次数较少（P<0.05）。外固定架组患儿在恢复日常生活屈伸活动度（ROM-ADL）时间上较克氏针组显著缩短（P<0.05）。最后一次复查两组患儿提携角、肘关节活动度（ROM）及Flynn评分无显著统计学差异（P>0.05）。随访时间6~29个月，两组患儿未出现医源性副损伤及其他严重并发症。结论 外侧克氏针和"Slongo's"外固定架均是治疗大龄儿童肱骨髁上骨折的有效手段。如果手术采用单纯克氏针固定，建议首选外侧穿针作为置钉方式，手术较为安全简便，术中透视次数更少；外固定架术后可以实现肘关节的早期活动，使患儿肘关节更早地恢复正常的功能。

Abstract:

Objective To compare the therapeutic effect of lateral entry pinning and "Slongo's" external fixator in the treatment of supracondylar humeral fractures in older children. Methods A retrospective analysis was performed on 52 children with supracondylar humeral fracture aged over 8 years, who were admitted to our hospital from January 2016 to December 2020. One group received closed reduction and lateral entry pinning and the other group underwent "Slongo's" external fixator surgery. The basic conditions of the two groups were compared. Postoperative reexamination and follow-up were conducted to evaluate the elbow function and observe the incidence of complications in the children.Results There was no significant difference in the basic information between the two groups. All the children were followed up for 6 to 29 months, with an average of 16 months. Compared with external fixation, Kirschner wire surgery had shorter length of hospital stay,operative time and fewer fluoroscopic times (P<0.05). Compared with the Kirschner wire group, the recovery time of ROM-ADL in the external fixator group was significantly shorter(P<0.05). At the last follow-up, there were no statistically significant differences in carrying Angle, elbow motion (ROM)and Flynn score between the two groups (P>0.05). There were no iatrogenic injuries and other serious complications in the two groups.Conclusion Both lateral entry pinning and "Slongo's" external fixator are effective methods for the treatment of supracondylar fracture of humerus in older children. When Kirschner wire is selected as the surgical method, lateral entry pinning is recommended as the first choice because the operation is safer and simpler, and the number of fluoroscopy is less. The external fixator can achieve early movement of the elbow so that the child's elbow can return to normal function sooner.