术中手法复位与克氏针撬拨复位治疗完全移位儿童肱骨髁上Gartland Ⅲ型骨折疗效对比

陈进; 车伟; 朱庆华; 王强

doi:10.11659/jjssx.10E023049

您当前的位置：

首页 >

文章列表页 >

术中手法复位与克氏针撬拨复位治疗完全移位儿童肱骨髁上Gartland Ⅲ型骨折疗效对比

临床研究 | 更新时间：2024-11-18

- 术中手法复位与克氏针撬拨复位治疗完全移位儿童肱骨髁上Gartland Ⅲ型骨折疗效对比
- Comparison of intraoperative manual reduction and Kirschner wire prying reduction in the treatment of completely displaced supracondylar Gartland type Ⅲ fracture of humerus in children
- 局解手术学杂志 2024年33卷第11期页码：1014-1017
- 作者机构：
  
  皖南医学院弋矶山医院小儿外科，安徽芜湖 241000
- 作者简介：
  
  车伟，E-mail：chewei107119@126.com
- 基金信息：
  
  安徽省科研编制计划项目(2022AH040170)
- DOI：10.11659/jjssx.10E023049
  中图分类号： R683.4
- 纸质出版日期：2024-11-25，
  
  收稿日期：2023-10-11，
- 稿件说明：
移动端阅览
陈进,车伟,朱庆华等.术中手法复位与克氏针撬拨复位治疗完全移位儿童肱骨髁上Gartland Ⅲ型骨折疗效对比[J].局解手术学杂志,2024,33(11):1014-1017.

CHEN Jin,CHE Wei,ZHU Qing-hua,et al.Comparison of intraoperative manual reduction and Kirschner wire prying reduction in the treatment of completely displaced supracondylar Gartland type Ⅲ fracture of humerus in children[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(11):1014-1017.
陈进,车伟,朱庆华等.术中手法复位与克氏针撬拨复位治疗完全移位儿童肱骨髁上Gartland Ⅲ型骨折疗效对比[J].局解手术学杂志,2024,33(11):1014-1017. DOI： 10.11659/jjssx.10E023049.

CHEN Jin,CHE Wei,ZHU Qing-hua,et al.Comparison of intraoperative manual reduction and Kirschner wire prying reduction in the treatment of completely displaced supracondylar Gartland type Ⅲ fracture of humerus in children[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(11):1014-1017. DOI： 10.11659/jjssx.10E023049.

摘要

目的

对比术中应用手法复位与克氏针撬拨复位治疗完全移位儿童肱骨髁上Gartland Ⅲ型骨折的疗效。

方法

选取2021年9月至2022年4月于我院就诊的完全移位肱骨髁上Gartland Ⅲ型骨折44例患儿，随机分为撬拨组和手法组，每组22例。比较2组患儿手术时间、术中透视次数、骨折愈合时间、术后6个月疗效以及术后并发症（感染、尺神经损伤、骨化性肌炎、肘内外翻畸形）情况。

结果

44例患儿均完成手术，无切开病例，其中手法组患儿有2例多次尝试手法复位不满意，术中改克氏针撬拨复位，剔除手法组中该2例患儿。撬拨组患儿手术时间为（39.59±5.59）min，短于手法组的（57.50±9.28）min；撬拨组患儿术中透视次数为（7.73±1.98）次，少于手法组的（15.60±3.20）次，差异均有统计学意义（

0.05）。术后6个月，2组患儿疗效优良率比较，差异无统计学意义（

0.05）。所有骨折均于术后4~6周愈合，2组患儿骨折愈合时间及术后并发症发生率比较，差异无统计学意义（

0.05）。

结论

对于儿童完全移位肱骨髁上Gartland Ⅲ型骨折，术中克氏针撬拨复位可缩短手术时间，减少术中透视次数，是一种具有安全、方便、可靠、创伤小等优点的复位方法。

Abstract

Objective

To compare the effects of intraoperative manual reduction and Kirschner wire prying reduction in the treatment of completely displaced supracondylar Gartland type III fracture of humerus in children.

Methods

Forty-four children with completely displaced supracondylar Gartland type III fracture of humerus who came to our hospital from September 2021 to April 2022 were selected and randomly divided into the prying group and the manual group， with 22 cases in each group.The operation time，number of intraoperative fluoroscopy， fracture healing time， curative effect 6 months after operation and postoperative complications （infection， ulnar nerve injury， myositis ossificans， elbow inversion deformity） were compared between the two groups.

Results

All 44 children completed surgery，without incision cases. In the manual group， 2 children were dissatisfied with manual reduction after repeated attempts and finally changed to Kirschner wire prying reduction，who were excluded in the follow-up study.The operation time was （39.59±5.59） minutes in the prying group， which was shorter than that of （57.50±9.28） minutes in the manual group； the number of intraoperative fluoroscopy was （7.73±1.98） in the prying group， which was less than that of （15.60±3.20） in the manual group， and the differences were statistically significant （

0.05）. Six months after operation， there was no significant difference in the excellent and good rate of curative effect between the two groups （

0.05）.All the fractures healed from 4 to 6 weeks after surgery. There was no significant difference in the healing time or incidence of postoperative complications between the two groups （

0.05）.

Conclusion

For completely displaced supracondylar Gartland type III fracture of humerus in children， Kirschner wire prying reduction can shorten operation time and reduce intraoperative fluoroscopy，which is a safe，convenient， reliable reduction method with less traumas.

关键词

克氏针骨折肱骨髁上撬拨复位手法复位临床疗效

Keywords

Kirschner wirefracturesupracondylar of humerusprying reductionmanual reductionclinical effect

references

Kropelnicki A，Ali AM，Popat R，et al.Paediatric supracondylar humerus fractures［J］.Br J Hosp Med （Lond），2019，80（6）：312-316.doi：10.12968/hmed.2019.80.6.312http://dx.doi.org/10.12968/hmed.2019.80.6.312.

Duffy S，Flannery O，Gelfer Y，et al.Overview of the contemporary management of supracondylar humeral fractures in children［J］.Eur J Orthop Surg Traumatol，2021，31（5）：871-881.doi：10.1007/s00590-021-02932-2http://dx.doi.org/10.1007/s00590-021-02932-2.

周志林,马海龙,孙军,等.拇指拨挡技术在儿童Gartland Ⅲ型肱骨髁上骨折尺侧穿克氏针中的应用[J].中国修复重建外科杂志,2023,37(2):142-146.doi：10.7507/1002-1892.202210085http://dx.doi.org/10.7507/1002-1892.202210085.

Mulpuri K，Hosalkar H，Howard A.AAOS clinical practice guideline： the treatment of pediatric supracondylar humerus fractures［J］.J Am Acad Orthop Surg，2012，20（5）：328-330. doi： 10.5435/JAAOS-20-05-328http://dx.doi.org/10.5435/JAAOS-20-05-328.

Hsu RY， Lareau CR， Kim JS， et al. The effect of C-arm position on radiation exposure during fixation of pediatric supracondylar fractures of the humerus［J］.J Bone Joint Surg Am，2014，96（15）：e129. doi： 10.2106/JBJS.M.01076http://dx.doi.org/10.2106/JBJS.M.01076.

Gartland JJ. Management of supracondylar fractures of the humerus in children［J］. Surg Gynecol Obstet，1959，109（2）：145-154.

Omid R， Choi PD， Skaggs DL. Supracondylar humeral fractures in children［J］.J Bone Joint Surg Am，2008，90（5）：1121-1132. doi： 10.2106/JBJS.G.01354http://dx.doi.org/10.2106/JBJS.G.01354.

张文兵，刘星，何金洲，等.切开复位克氏针内固定+石膏外固定治疗儿童Gartland Ⅲ型陈旧性肱骨髁上骨折［J］.中华创伤杂志，2018，34（5）：420-425. doi：10.3760/cma.j.issn.1001-8050.2018. 05.007http://dx.doi.org/10.3760/cma.j.issn.1001-8050.2018.05.007.

Farr S， Scheider P. The molding hands of time： remodeling of sagittal plane malunion after pediatric supracondylar humerus fractures［J］.J Pediatr Orthop，2021，41（8）：e700. doi： 10.1097/BPO.00000 00000001895http://dx.doi.org/10.1097/BPO.0000000000001895.

Battle J，Carmichael KD.Incidenc of pin track infections in children's fractures treated with Kirschner wire fixation［J］.J Pediatr Orthop， 2007，27（2）：154-157.doi： 10.1097/bpo.0b013e3180317a22http://dx.doi.org/10.1097/bpo.0b013e3180317a22.

曹志洪，段晓堃，霍英才，等.闭合复位经皮穿针内固定治疗小儿Gartland Ⅲ型肱骨髁上骨折［J］.中国骨与关节损伤杂志，2020，35（3）：307-308.doi：10.7531/j.issn.1672-9935.2020.03.032http://dx.doi.org/10.7531/j.issn.1672-9935.2020.03.032.

周游，刘萌，廖俊城，等.闭合复位经皮交叉克氏针不同置针方式固定治疗严重儿童肱骨髁上骨折的疗效比较［J］.中国中医骨伤科杂志，2019，27（9）：20-24.

刘祥飞，刘闯，王恩波，等.儿童肱骨髁上骨折模型克氏针固定构型的三维有限元分析［J］.中国骨伤，2020，33（10）：948-953.doi：10.12200/j.issn.1003-0034.2020.10.012http://dx.doi.org/10.12200/j.issn.1003-0034.2020.10.012.

Poggiali P，Nogueira FCS，Nogueira MPM.Management of supracondylar humeral fracture in children［J］.Rev Bras Ortop （Sao Paulo），2020，57（1）：23-32.doi：10.1055/s-0040-1709734http://dx.doi.org/10.1055/s-0040-1709734.

印飞，王军，沈小芳，等.闭合撬拨复位克氏针固定治疗儿童难复性指骨颈骨折［J］.中华手外科杂志，2020，36（1）：20-22.doi：10.3760/cma.j.issn.1005-054X.2020.01.005http://dx.doi.org/10.3760/cma.j.issn.1005-054X.2020.01.005.

陈彦，林琳，严小林，等.四肢骨折术后切口感染病原菌及危险因素［J］.中华医院感染学杂志，2021，31（2）：259-263.doi：10.11816/cn.ni.2021-201284http://dx.doi.org/10.11816/cn.ni.2021-201284.

Archibeck MJ，Scott SM，Peters CL.Brachialis muscle entrapment in displaced supracondylar humerus fractures：a technique of closed reduction and report of initial results［J］.J Pediatr Orthop，1997，17（3）：298-302.doi：10.1097/01241398-199705000-00006http://dx.doi.org/10.1097/01241398-199705000-00006.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

TWIST评分在睾丸扭转诊疗中的应用

皮外钢板技术与微创接骨板技术治疗胫骨远端粉碎性骨折

创伤性胸腰椎骨折的临床特点分析

髋关节融合术治疗晚期髋关节结核的疗效评估