闭合复位与切开复位交叉克氏针内固定治疗儿童Gartland Ⅲ型肱骨髁上骨折的对比研究OA
A comparative study of closed reduction versus open reduction and crossed Kirschner wire internal fixation in the treatment of Gartland type Ⅲ supracondylar humeral fractures in children
目的:比较闭合复位与切开复位交叉克氏针内固定治疗儿童Gartland Ⅲ型肱骨髁上骨折的临床疗效与安全性.方法:回顾性分析2020年1月至2024年12月在杭州市儿童医院收治的133例Gartland Ⅲ型肱骨髁上骨折患儿的病例资料,其中采用闭合复位交叉克氏针内固定77例(闭合复位组),采用切开复位交叉克氏针内固定56例(切开复位组).比较2组患儿的手术时间、住院时间、术中失血量、骨折愈合时间、术后24 h患肢疼痛视觉模拟量表(visual analogue scale,VAS)评分,术后3个月、6个月骨折愈合情况、提携角与Baumann角,术后6个月综合疗效,以及并发症发生情况.结果:①一般情况.闭合复位组手术时间、住院时间、骨折愈合时间均短于切开复位组(t=20.256,P=0.000;t=15.692,P=0.000;t=15.553,P=0.000),术中失血量少于切开复位组(t=53.236,P=0.000),术后24 h患肢疼痛VAS评分低于切开复位组(t=39.601,P=0.000).②骨折愈合情况.术后3个月、6个月,闭合复位组骨折愈合率均高于切开复位组(x2=9.872,P=0.002;x2=17.015,P=0.000).③提携角和Baumann角.术后3个月、6个月,2组提携角、Baumann角的组间差异均无统计学意义(提携角:t=0.533,P=0.595;t=0.377,P=0.707.Baumann角:t=0.103,P=0.918;t=1.392,P=0.166).④综合疗效.术后6个月,闭合复位组优40例、良22例、一般12例、差3例,切开复位组优13例、良20例、一般12例、差11例;闭合复位组综合疗效优于切开复位组(R闭合复位组=56.990,R切开复位组=80.760,Z=-3.705,P=0.000).⑤安全性.闭合复位组12例发生轻微尺、桡神经损伤,切开复位组16例发生轻微尺、桡神经损伤,2组均未发生针道感染、骨折再移位、肘关节僵硬等并发症;2组并发症发生率比较,差异无统计学意义(x2=3.290,P=0.070).结论:对于儿童Gartland Ⅲ型肱骨髁上骨折,采用闭合复位与切开复位交叉克氏针内固定治疗均能恢复肱骨远端正常解剖结构,且安全性高;但前者比后者手术时间及住院时间短,术中失血少,术后疼痛轻,更有利于骨折愈合,综合疗效更佳.
Objective:To compare the clinical efficacy and safety of closed reduction versus open reduction and crossed Kirschner wire(K-wire)internal fixation in the treatment of Gartland type Ⅲ supracondylar humeral fractures(SCHFs)in children.Methods:The medical records of 133 children with Gartland type Ⅲ SCHFs treated at Hangzhou Children's Hospital from January 2020 to December 2024 were analyzed retrospectively.Among them,77 children underwent closed reduction and crossed K-wire internal fixation(closed reduction group),and 56 ones with open reduction and crossed K-wire internal fixation(open reduction group).The operative time,hospital stay,intr-aoperative blood loss,fracture healing time,affected limb pain visual analogue scale(VAS)score evaluated at 24-hour post-surgery,fracture healing status at 3-and 6-month post-surgery,carrying angle and Baumann angle,comprehensive therapeutic outcome evaluated at 6-month post-surgery,as well as the incidence of complications,were compared between the two groups.Results:①General outcomes.The closed re-duction group showed shorter operative time,hospital stay,and fracture healing time compared to the open reduction group(t=20.256,P=0.000;t=15.692,P=0.000;t=15.553,P=0.000),as well as less intraoperative blood loss(t=53.236,P=0.000)and lower affected limb pain VAS score evaluated at 24-hour post-surgery(t=39.601,P=0.000).②Fracture healing status.At 3-and 6-month post-surgery,the closed reduction group showed superior fracture healing compared to the open reduction group(x2=9.872,P=0.002;x2=17.015,P=0.000).③Carrying angle and Baumann angle.No significant differences were observed between the two groups in carrying angle or Bau-mann angle at 3-and 6-month post-surgery(carrying angle:t=0.533,P=0.595;t=0.377,P=0.707;Baumann angle:t=0.103,P=0.918;t=1.392,P=0.166).④Comprehensive therapeutic outcome.At 6-month post-surgery,the closed reduction group achieved excel-lent outcome in 40 cases,good in 22 cases,fair in 12 cases,and poor in 3 cases;the open reduction group achieved excellent outcome in 13 cases,good in 20 cases,fair in 12 cases,and poor in 11 cases.The closed reduction group demonstrated significantly better comprehen-sive outcomes than the open reduction group(Rclosed reduction group=56.990,Ropen reduction group=80.760,Z=-3.705,P=0.000).⑤Safety.Twelve children in the closed reduction group and 16 cases in the open reduction group experienced mild ulnar and radial nerve injuries.No complications such as pin tract infection,fracture re-displacement,or elbow joint stiffness were observed in either group.There was no sig-nificant difference in the incidence of complications between the two groups(x2=3.290,P=0.070).Conclusion:Both closed reduction and open reduction combined with crossed K-wire internal fixation can effectively restore the normal anatomical structure of the distal hume-rus with high safety in treatment of Gartland type Ⅲ SCHFs in children.However,compared to open reduction,the closed reduction offers ad-vantages such as shorter operative time and hospital stay,less intraoperative blood loss,and reduced post-surgery pain,which are more con-ducive to fracture healing.Its comprehensive efficacy is better than that of open reduction.
洪东升;王浩然;王汉卿;吴鹏;刘子祥
杭州市儿童医院,浙江 杭州 310014杭州市儿童医院,浙江 杭州 310014杭州市儿童医院,浙江 杭州 310014杭州市儿童医院,浙江 杭州 310014杭州市儿童医院,浙江 杭州 310014
肱骨骨折骨折固定术,内骨折闭合复位骨折切开复位骨钉儿童临床试验专题
humeral fracturesfracture fixation,internalclosed fracture reductionopen fracture reductionbone nailschildclinical trials as topic
《中医正骨》 2026 (4)
33-38,6
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