儿童肱骨内上髁骨折克氏针和螺钉固定效果比较

 目的 比较克氏针和螺钉治疗儿童肱骨内上髁骨折临床疗效。方法 回顾性分析北京儿童医院2013-01至2018-01收治的31例儿童肱骨内上髁骨折患者。按照治疗方法分为克氏针组(采用切开复位克氏针内固定,17例)和螺钉组(采用切开复位螺钉内固定,14例)。比较两组的临床特征、骨折愈合时间、功能外观恢复及并发症情况。结果 31例患儿均获随访,随访时间6~24个月(平均16个月),两组在骨折愈合时间、末次随访肘关节功能及外观评分对比,差异均无统计学意义。螺钉组内固定取出时间为(45.7±10.6)d,克氏针组为(36.5±8.3)d,螺钉组长于克氏针组(P＜0.05);螺钉组肘关节功能恢复时间为(32.7±7.4)d,克氏针组为(39.5±6.8)d,螺钉组快于克氏针组(P＜0.05)。克氏针组术后出现2例针道感染,均为软组织感染,螺钉组中无钉道感染出现,随访时所有病例未发现外翻不稳定、尺神经炎,术前尺神经麻痹病例术后均逐渐消失,末次随访时所有患儿日常活动无受限。在末次随访中克氏针组出现1例骨过度增生钙化,1例尺神经沟畸形;螺钉组出现2例骨过度增生钙化。结论 移位超过5 mm的儿童肱骨内上髁骨折采用切开复位克氏针或螺钉固定治疗均可获得良好的预后,螺钉固定可以更快地恢复肘关节功能。对于骨骺闭合或接近闭合的青少年建议优先选择螺钉固定,而骨骺未闭合的低龄儿童建议选择克氏针固定。

Comparison of clinical effect of Kirschner wires and screws in treating humeral medial eplcondyle fractures in children and adolescents

Objective To compare the clinical effect of Kirsclner wire internal fixation and screw internal fixation in the treatment of humeral medial epicondyle fractures in children and adolescents.Methods The clinical data on 31 cases of children with humeral medial epicondyle fractures admitted to our hospital between January 2013 and January 2018 was retrospectively analyzed. According to surgical approaches, they were divided into two groups: the Kirschner group (open reduction plus Kirschner internal fixation, n=17) and the screw group (open reduction plus screw internal fixation, n=14).The clinical manifestations, healing time of fractures, functional appearance recovery and complications were analyzed and compared between the two groups.Results All the 31 cases were followed up for an average of 16 months. There was significant difference between the two groups in the time the internal fixation was removed (45.7±10.6)d vs(36.5±8.3)d] and the rate of recovery of elbow joints((32.7±7.4)d,vs(39.5±6.8)d] (P<0.05).There was no significant difference between the two groups in the healing time of fractures and results of evaluation of elbow joints during the last follow-up.Conclusions It is recommended that children with humeral medial epicondylar fractures that are displaced more than 5 mm be treated surgically. The use of smooth K-wires for younger children and screw fixation for adolescents near skeletal maturity might lead to favorable clinical and radiological outcomes during follow-up, with low morbidity and radiographic deformity.