两种方法治疗青少年肱骨髁上骨折的比较

摘要

目的 回顾性分析并比较应用经皮穿针与钢板固定治疗青少年肱骨髁上骨折的临床疗效.方法 依据入选标准,我院自2008年至2016年收治的青少年肱骨髁上骨折病例共52例入选,按治疗方法分为两组,经皮穿针固定34例,锁定加压钢板固定18例.分析比较手术时间、术中失血量、住院时间、住院费用、骨折愈合时间、肘关节功能及并发症发生率.结果 两组病例在性别、受伤距手术时间、骨折愈合时间方面差异无统计学意义,钢板组较克氏针组年龄及体质量偏大,手术时间及出血量、住院费用方面克氏针组显著低于钢板组.而在早期肘关节活动范围方面钢板组显著优于克氏针组,在并发症如皮肤及钉道感染、骨折复位丢失方面克氏针组较钢板组明显增多,但术后12个月随访肘关节活动范围两组比较差异无统计学意义.结论 对于青少年肱骨髁上骨折,克氏针和钢板两种方式均能在骨折复位后提供安全有效的内固定,但骨发育接近成熟的以及不稳定的肱骨髁上骨折闭合穿针较切开复位钢板固定的并发症发生率高,故对该类患儿建议选择切开复位钢板固定.%Objective To retrospective analyze and compare the clinical efficacy of percutaneous pin fixation and plate fixation for the treatment of humeral supracondylar fracture in adolescents. Methods From 2008 to 2016, a total of 52 adolescents with humeral supracondylar fracture were included in this study. According to the treatment methods, they were divided into two groups, 34 cases of percutaneous pin fixation and 18 cases of locking compression plate fixation. The operation time, blood loss, hospitalization time, hospitalization expenses, fracture healing time, elbow function and incidence of complications were analyzed and compared. Results There was no statistically significant difference between the two groups in gender, the time between injury and operation, fracture healing time. The age and body mass of the patients in plate fixation group were larger than those in Kirschner wire group. The operation time, blood loss and hospitalization expenses of Kirschner wire group were significantly lower than those of plate fixation group. The elbow motion range of plate fixation group was significantly better than that of Kirschner wire group at the early stage, while the complications such as skin and pin tract infection and fracture reduction loss of Kirschner wire group were more than those of plate fixation group. However, there was no statistical difference between the two groups of elbow motion range 12 months after the operation. Conclusion For the humeral supracondylar fractures in adolescents, both of the Kirschner wire and plate can provide safe and effective internal fixation after fracture reduction. Closed percutaneous pin fixation will cause higher incidence of complications than open reduction and plate fixation in the treatment of the patients with bone development close to mature and unstable humeral supracondylar fracture. Therefore, it is recommended to choose open reduction and plate fixation for this kind of adolescents.