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目的比较交叉克氏针内固定和外侧两枚克氏针内固定两种术式治疗儿童创伤性肱骨髁上闭合性骨折的临床疗效,为儿童肱骨髁上骨折的治疗积累临床经验和提供参考。方法从骨科2012年5月至2014年5月收治的创伤性肱骨髁上骨折患儿中,依据纳入标准,选取196例行克氏针内固定治疗的儿童为随访对象。采用回顾性研究方法,按照手术方式,将被随访儿童分为交叉克氏针内固定组(A组,104例)和外侧两枚克氏针内固定组(B组,92例)。随访时间6~18个月,平均10.8个月。比较两组患儿的手术时间、骨折愈合时间、Flynn评价优良率以及术后并发症等数据。结果 A组患儿骨折再移位率为1.92%,B组为8.70%,A组稍低于B组,但差异无统计学意义(P>0.05);A组患儿尺神经损伤率为7.69%,B组为1.09%,A组稍高于B组,但差异无统计学意义(P>0.05)。两组患儿住院天数、手术时间、骨折愈合时间、Flynn评价优良率及其他并发症情况对比亦无统计学差异(P均>0.05)。结论两种术式治疗儿童创伤肱骨髁上闭合性骨折的临床疗效均较为理想;两种固定方式在尺神经损伤和固定牢固程度方面各有优劣;可通过规范手术操作或适当增加外侧克氏针内固定数量进一步改善疗效。
Objective To compare the clinical effects of two Kirschner wire internal fixation with Kirschner wire fixation and lateral Kirschner wire internal fixation on children with traumatic supracondylar humeral fractures, and to accumulate clinical experience and provide references for the treatment of supracondylar humerus fractures in children. Methods From January 2012 to May 2014, orthopedic children with traumatic supracondylar humerus fractures were enrolled. According to the inclusion criteria, 196 children undergoing Kirschner wire internal fixation were selected as the follow-up objects. A retrospective study was conducted. According to the surgical procedure, the children were divided into three groups: group A (n = 104) and group K (n = 92). Follow-up time of 6 to 18 months, an average of 10.8 months. The operation time, fracture healing time, the excellent rate of Flynn evaluation and postoperative complications were compared between the two groups. Results In group A, the rate of fracture relocation was 1.92% in group A, 8.70% in group B, and slightly lower in group A than in group B (P> 0.05). The rate of ulnar nerve injury in group A was 7.69 %, B group was 1.09%, A group slightly higher than B group, but the difference was not statistically significant (P> 0.05). There was no significant difference between the two groups in hospitalization days, operation time, fracture healing time, the excellent rate of Flynn evaluation and other complications (all P> 0.05). Conclusion The two kinds of surgical treatment of traumatic supracondylar humeral fractures in children are more ideal clinical efficacy; the two fixation methods in the ulnar nerve injury and fixation of the strengths and weaknesses; by standard surgical procedures or appropriate increase in lateral Kirschner Acupuncture to further improve the number of fixed effect.