两种肘内侧微创内固定术治疗青少年肱骨内上髁骨折的对比研究OA
Comparison of two minimally invasive internal fixation techniques for the treatment of humeral medial epicondylar fractures in adolescent
目的 对比分析小切口辅助克氏针操纵杆技术撬拨复位内固定与小切口置入克氏针交叉内固定治疗青少年肱骨内上髁骨折的临床效果.方法 回顾性分析2021年1月至2024年1月我院收治的94例肱骨内上髁骨折患儿的临床资料,根据手术方案的不同将其分为操纵杆组(47例)和交叉固定组(47例).操纵杆组患儿采用小切口辅助克氏针操纵杆技术撬拨复位内固定治疗,交叉固定组患儿采用小切口置入克氏针交叉内固定治疗.比较2组患儿围术期情况、手术前后骨代谢指标、静息和活动视觉模拟量表(VAS)评分、肘关节活动度、肘关节功能恢复情况及并发症发生情况.结果 操纵杆组患儿手术时间、术后住院时间、骨折愈合时间、术中透视次数短/少于交叉固定组(P<0.05).术后1个月,操纵杆组患儿静息、活动VAS评分均低于交叉固定组(P<0.05),血清护骨因子(OPG)、骨钙素(BGP)水平高于交叉固定组(P<0.05),胶原C端肽(CTX)水平低于交叉固定组(P<0.05).操纵杆组患儿术后3个月、6个月、12个月的肘关节屈曲、伸直及前臂旋前、旋后活动度均大于交叉固定组(P<0.05).操纵杆组患儿肘关节功能恢复优良率高于交叉固定组(P<0.05).2组患儿均无并发症发生.结论 相较于小切口置入克氏针交叉内固定,使用小切口辅助克氏针操纵杆技术撬拨复位内固定治疗青少年肱骨内上髁骨折具有手术效率高、透视次数少、术后疼痛轻、骨折愈合快、更利于关节功能恢复的优势,且不会增加术后并发症风险.
Objective To compare and analyze the clinical efficacy of small incision-assisted Kirschner wire joystick technique for prying reduction and internal fixation versus small-incision Kirschner wire cross-internal fixation in the treatment of humeral medial epicondylar fractures in adolescent.Methods A retrospective analysis was conducted on the clinical data of 94 pediatric patients with humeral medial epicondylar fractures admitted to our hospital from January 2021 to January 2024.They were divided into the joystick group(47 cases)and the cross-fixation group(47 cases)based on different surgical protocols.Patients in the joystick group underwent small incision-assisted Kirschner wire joystick technique for prying reduction and internal fixation,while patients in the cross-fixation group received small-incision Kirschner wire cross-internal fixation.Perioperative indicators,bone metabolism markers before and after surgery,visual analogue scale(VAS)scores at rest and during activity,elbow range of motion,elbow function recovery,and complication of patients were compared between the two groups.Results The joystick group had significantly shorter operation time,postoperative hospital stay,fracture healing time,and fewer intraoperative fluoroscopy frequency compared to the cross-fixation group(P<0.05).One month after surgery,the joystick group showed lower VAS scores at rest and during activity(P<0.05),higher serum levels of osteoprotegerin(OPG)and bone gla protein(BGP)(P<0.05),and a lower level of collagen C-terminal telopeptide(CTX)compared to the cross-fixation group(P<0.05).The joystick group demonstrated greater ranges of elbow flexion and extension,forearm pronation and supination than the cross-fixation group 3,6,and 12 months after surgery(P<0.05).The excellent and good rate of elbow function recovery was higher in the joystick group than that in the cross-fixation group(P<0.05).No complications occurred in either group.Conclusion Compared with the small-incision Kirschner wire cross-internal fixation,the use of small incision-assisted Kirschner wire joystick technique for prying reduction and internal fixation in the treatment of adolescent humeral medial epicondylar fractures has the advantages of higher surgical efficiency,fewer fluoroscopy frequency,less postoperative pain,faster fracture healing,and better joint function recovery,without increasing the risk of postoperative complications.
常红;万广亮
唐山市第二医院手术室,河北 唐山 063000唐山市第二医院小儿骨科,河北 唐山 063000
医药卫生
肱骨内上髁骨折小切口复位克氏针内固定
humeral medial epicondylar fracturessmall incisionreductioninternal fixation with Kirschner wire
《局解手术学杂志》 2026 (4)
281-285,5
河北省医学科学研究重点课题计划项目(20242040)
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