| 贾婉婉,马 斌.不同方法治疗大龄儿童不稳定型尺桡骨远端骨折疗效对比[J].中国烧伤创疡杂志,2024,(6):455~459. |
| DOI： |
| 中文关键词: 手法复位 石膏外固定 经皮克氏针内固定 切开复位接骨板 经皮弹性髓内针内固定 不稳定型尺桡骨远端骨折 儿童 |
| 英文关键词:Manual reduction Plaster external fixation Percutaneous K-wire internal fixation Open reduction percutaneous plate Percutaneous elastic intramedullary nailing internal fixation Unstable distal ulna and radius fracture Children |
| 基金项目: |
|
| 摘要点击次数: 702 |
| 全文下载次数: 1454 |
| 中文摘要: |
| 【摘要】 目的 对比分析不同方法 (手法复位联合石膏外固定、手法复位联合经皮克氏针内固定、切开复位接骨板联合经皮弹性髓内针内固定) 治疗大龄儿童不稳定型尺桡骨远端骨折的应用效果。方法 选取 2020 年6 月至 2022 年 6 月河南科技大学第一附属医院收治的 90 例大龄不稳定型尺桡骨远端骨折患儿作为研究对象, 按照不同治疗方法将其分为石膏固定组 (27 例)、克氏针固定组 (37 例)、切开复位组 (26 例), 石膏固定组患儿行手法复位联合石膏外固定治疗, 克氏针固定组患儿行手法复位联合经皮克氏针内固定治疗, 切开复位组患儿行切开复位接骨板联合经皮弹性髓内针内固定治疗, 对比观察 3 组患儿手术相关指标、腕关节功能及并发症发生情况。结果 石膏固定组患儿手术时间及住院时间均明显短于克氏针固定组与切开复位组 (手术时间: q = 6.807?16.560, P 均<0.001；住院时间: q = 8.850、16.530, P 均<0.001), 且克氏针固定组明显短于切开复位组 ( q =11.051、8.994, P 均<0.001), 而骨折愈合时间 3 组间无明显差异 (F = 2.622, P = 0.078); 术后 3 个月, 石膏固定组患儿腕关节掌屈、背伸、桡偏、旋前、旋后活动度均明显小于切开复位组 ( q = 3.407、3.772、3.386?3.740、3.413, P= 0.047、0.025、0.049、0.026、0.047), 而石膏固定组与克氏针固定组以及克氏针固定组与切开复位组间均无明显差异 (石膏固定组与克氏针固定组: q = 3.140、3.053、2.943、3.156、2.890, P = 0.073?0.084、0.100、0.072、0.108; 克氏针固定组与切开复位 组: q = 0.553、1.031、0.724、0.894、0.806, P =0.919、0.747、0.866、0.803、0.837); 术后 3 个月, 石膏固定组患儿改良 Mcbridge 腕关节功能评分为优 15 例、良 8 例、可 3 例、差 1 例, 克氏针固定组患儿改良 Mcbridge 腕关节功能评分为优 26 例、良 8 例、可 3 例, 切开复位组患儿改良 Mcbridge 腕关节功能评分为优 20 例、良 4 例、可 2 例, 3 组间无明显差异 (Z = - 1.265, P =0.206)。石膏固定组患儿术后并发症发生率为 11.11%, 克氏针固定组患儿术后并发症发生率为 8.11%, 切开复位组患儿术后并发症发生率为 3.85%, 3 组间无明显差异 ( χ2 = 0.987, P = 0.611)。结论 手法复位联合石膏外固定、手法复位联合经皮克氏针内固定、切开复位接骨板联合经皮弹性髓内针内固定均能有效促进大龄不稳定型尺桡骨远端骨折患儿骨折愈合及腕关节功能恢复, 但手法复位联合经皮克氏针内固定能兼顾手法复位联合石膏外固定治疗后腕关节活动度差以及切开复位接骨板联合经皮弹性髓内针内固定手术时间及住院时间长等不足, 临床应用价值更高。 |
| 英文摘要: |
| 【Abstract】 Objective To compare the clinical efficacy of different treatment methods (manual reduction combined with plaster external fixation, manual reduction combined with percutaneous K?wire internal fixation, open reduction percu-taneous plate combined with percutaneous elastic intramedullary nailing internal fixation) for unstable distal ulna and radius
fracture in older children. Methods Ninety older children with unstable distal ulna and radius fracture admitted to The First Affiliated Hospital of Henan University of Science and Technology from June 2020 to June 2022 were enrolled as the research subjects, and were divided into plaster fixation group (n = 27), K?wire fixation group (n = 37) and open reduction group (n = 26). The children in the plaster fixation group were treated with manual reduction combined with plaster external fixation, the children in the K-wire fixation group were treated with manual reduction combined with percutaneous K-wire internal fixation, and the children in the open reduction group were treated with open reduction percutaneous plate combined with percutaneous elastic intramedullary nailing internal fixation. The surgery?related indexes, wrist joint function and the occurrence of complications were compared between the three groups. Results The operation time and length of stay of children patients were significantly shorter in the plaster fixation group respectively compared with the K?wire fixation group and the open reduction group ( operation time: q = 6.807 and 16.560, both P < 0.001; length of stay: q = 8.850 and 16.530, both P<0.001), and the operation time and length of stay of children patients were significantly shorter in the K-wire fixation group compared with the open reduction group (q = 11.051 and 8.994, both P<0.001), while there was no significant difference in fracture healing time among the three groups (F= 2.622, P= 0.078). On month 3 after operation, the palm flexion, dorsal extension, radial deviation, pronation and supination ranges of the wrist joint were significantly lower in the plaster fixation group compared with the open reduction group (q = 3.407, 3.772, 3.386, 3.740 and 3.413, P= 0.047, 0.025, 0.049, 0.026 and 0.047), while there was no significant difference between the plaster fixation group and the K-wire fixation group, or between the K-wire fixation group and the open reduction group (plaster fixation group and K-wire fixation group: q = 3.140, 3.053, 2.943, 3.156 and 2.890, P= 0.073, 0.084, 0.100, 0.072 and 0.108; K-wire fixation group and open reduction group: q = 0.553, 1.031, 0.724, 0.894 and 0.806, P= 0.919, 0.747, 0.866, 0.803 and 0.837). On month 3 after operation, the modified Mcbridge wrist function scoring was excellent in 15 cases, good in 8 cases, fair in 3 cases, poor in 1 case in the plaster fixation group, excellent in 26 cases, good in 8 cases, fair in 3 cases in the K-wire fixation group, and excellent in 20 cases, good in 4 cases, fair in 2 cases in the open reduction group, and there were no significant differences among the three groups (Z= -1.265, P= 0.206). The incidence of postoperative complica-tions was 11.11% in the plaster fixation group, 8.11% in the K-wire fixation group, and 3.85% in the open reduction group, among which there were no significant differences ( χ2 = 0.987, P = 0.611). Conclusion The three methods -manual reduction combined with plaster external fixation, manual reduction combined with percutaneous K-wire internal fixation, and open reduction percutaneous plate combined with percutaneous elastic intramedullary nailing internal fixation all can effectively promote fracture healing and wrist joint function recovery of older children with unstable distal ulna and radius fracture. However, manual reduction combined with percutaneous K?wire internal fixation can free from the shortcomings such as poor wrist mobility after manual reduction combined with plaster external fixation, long operation time and length of stay in the method of open reduction percutaneous plate combined with percutaneous elastic intramedullary nailing internal fixation, and realize better clinical efficacy. |
|
|
|
|
