手法复位经皮克氏针固定治疗肱骨远端全骺分离疗效观察
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摘要
目的：
阐述小儿肱骨远端全骺分离的治疗研究进展,评价手法复位闭合克氏针内固定治疗小儿肱骨远端全骺分离的临床疗效,分析影响疗效的因素,为肱骨远端全骺分离治疗方案的选择提供临床依据。
方法：
回顾性分析40例符合纳入标准的肱骨远端全骺分离病例,分成手法复位闭合克氏针内固定(治疗组)和切开复位内固定(对照组)各20例,通过查阅病历及术后随访,分别观察两组的骨折临床愈合时间、分析术后6个月、12个月、18个月影像学资料(Baumann角、提携角),观察记录各种并发症诸如肘内翻畸形、骨折不愈合、神经血管损伤、治疗期间内固定松动退针、针口感染的发生情况等,进行统计学分析。采用Mayo肘关节评分、Flynn评价标准对术后关节功能及肘内翻情况进行评价。
成果：
对两组患者术后均采用Mayo肘关节评分,治疗组优良率85%,对照组优良率75%,有显著性差异(P<0.05)；按Flynn评价标准治疗组优良率80%,对照组优良率65%,有显著性差异(P<0.05)。治疗组在骨折愈合时间、术后随访影像学资料、肘内翻发生率方面均优于对照组。
结论：
①小儿肱骨远端全骺分离的治疗,对于无血管损伤的闭合性骨折患者,无手术适应症者均优先考虑手法复位经皮克氏针内固定治疗；有手术适应症者应及时切开复位内固定。②手法复位经皮克氏针内固定治疗肱骨远端全骺分离,其促进骨折愈合、关节功能康复均优于切开复位内固定,肘内翻发生率也低于切开复位内固定。③整体评价手法复位经皮克氏针内固定治疗肱骨远端全骺分离,其优良率高于切开复位内固定,能获得较好的关节康复,降低肘内翻发生率,而且微创、经济,值得临床上推广应用。
Objective
This research is about distal humeral epiphysis separation treatment research progress, and evaluation technique closed reduction, kwire fixation in treating pediatric distal humeral epiphysis all the clinical curative effect of separation, analyzes the factors affect curative effect, for distal humeral epiphysis separation treatment options provide clinical evidence.
Methods
40cases were analyzed retrospectively with into standard distal humerus all cases Hou separation, divided into gimmick closed reduction, kwire fixation (treatment group) open reduction and internal fixation (control group) every20cases, access to medical records and postoperative follow-up, the two groups were observed the fracture healing time, analysis the clinical after one year imaging data (Baumann Angle, support the Angle), observation records of the complications such as cubitus varus, fracture of elbow don't heal, nerve vascular injury during the treatment period, fixation back loose needles, mouth of infection, the statistical analysis. The Mayo elbow score, Flynn evaluation standard of postoperative function of elbow joint and turned to evaluate the situation.
Results
Two groups of patients with all the Mayo elbow score, the treatment group was85%, and the control group was75%, the significant difference (P<0.05); According to the Flynn evaluation standard treatment group was80%, and the control group was65%, the significant difference (P<0.05). The treatment group in the healing time, follow-up of imaging material, elbow turn inward, are better than the control group incidence.
Conelusion
(1) distal humerus all children Hou separation treatment, for no of vascular injury patients with fracture of the closed, no operation indications are the preferred methods by Gerard pique's reset needle internal fixation for; With operation indications should be timely open reduction and internal fixation.(2) the technique by Gerard pique's reset needle internal fixation for distal humerus all the Hou separation, promote the fracture healing, joint function recovery is better than open reduction and internal fixation, cubits rate lower than in turn open reduction and internal fixation.(3) the overall evaluation technique by Gerard pique's reset needle internal fixation for distal humerus all the Hou separation, was higher than the open reduction and internal fixation, can achieve good joint rehabilitation, reduce the incidence of elbow turn, and minimally invasive, economic, and clinical application.
阐述小儿肱骨远端全骺分离的治疗研究进展,评价手法复位闭合克氏针内固定治疗小儿肱骨远端全骺分离的临床疗效,分析影响疗效的因素,为肱骨远端全骺分离治疗方案的选择提供临床依据。
方法：
回顾性分析40例符合纳入标准的肱骨远端全骺分离病例,分成手法复位闭合克氏针内固定(治疗组)和切开复位内固定(对照组)各20例,通过查阅病历及术后随访,分别观察两组的骨折临床愈合时间、分析术后6个月、12个月、18个月影像学资料(Baumann角、提携角),观察记录各种并发症诸如肘内翻畸形、骨折不愈合、神经血管损伤、治疗期间内固定松动退针、针口感染的发生情况等,进行统计学分析。采用Mayo肘关节评分、Flynn评价标准对术后关节功能及肘内翻情况进行评价。
成果：
对两组患者术后均采用Mayo肘关节评分,治疗组优良率85%,对照组优良率75%,有显著性差异(P<0.05)；按Flynn评价标准治疗组优良率80%,对照组优良率65%,有显著性差异(P<0.05)。治疗组在骨折愈合时间、术后随访影像学资料、肘内翻发生率方面均优于对照组。
结论：
①小儿肱骨远端全骺分离的治疗,对于无血管损伤的闭合性骨折患者,无手术适应症者均优先考虑手法复位经皮克氏针内固定治疗；有手术适应症者应及时切开复位内固定。②手法复位经皮克氏针内固定治疗肱骨远端全骺分离,其促进骨折愈合、关节功能康复均优于切开复位内固定,肘内翻发生率也低于切开复位内固定。③整体评价手法复位经皮克氏针内固定治疗肱骨远端全骺分离,其优良率高于切开复位内固定,能获得较好的关节康复,降低肘内翻发生率,而且微创、经济,值得临床上推广应用。
Objective
This research is about distal humeral epiphysis separation treatment research progress, and evaluation technique closed reduction, kwire fixation in treating pediatric distal humeral epiphysis all the clinical curative effect of separation, analyzes the factors affect curative effect, for distal humeral epiphysis separation treatment options provide clinical evidence.
Methods
40cases were analyzed retrospectively with into standard distal humerus all cases Hou separation, divided into gimmick closed reduction, kwire fixation (treatment group) open reduction and internal fixation (control group) every20cases, access to medical records and postoperative follow-up, the two groups were observed the fracture healing time, analysis the clinical after one year imaging data (Baumann Angle, support the Angle), observation records of the complications such as cubitus varus, fracture of elbow don't heal, nerve vascular injury during the treatment period, fixation back loose needles, mouth of infection, the statistical analysis. The Mayo elbow score, Flynn evaluation standard of postoperative function of elbow joint and turned to evaluate the situation.
Results
Two groups of patients with all the Mayo elbow score, the treatment group was85%, and the control group was75%, the significant difference (P<0.05); According to the Flynn evaluation standard treatment group was80%, and the control group was65%, the significant difference (P<0.05). The treatment group in the healing time, follow-up of imaging material, elbow turn inward, are better than the control group incidence.
Conelusion
(1) distal humerus all children Hou separation treatment, for no of vascular injury patients with fracture of the closed, no operation indications are the preferred methods by Gerard pique's reset needle internal fixation for; With operation indications should be timely open reduction and internal fixation.(2) the technique by Gerard pique's reset needle internal fixation for distal humerus all the Hou separation, promote the fracture healing, joint function recovery is better than open reduction and internal fixation, cubits rate lower than in turn open reduction and internal fixation.(3) the overall evaluation technique by Gerard pique's reset needle internal fixation for distal humerus all the Hou separation, was higher than the open reduction and internal fixation, can achieve good joint rehabilitation, reduce the incidence of elbow turn, and minimally invasive, economic, and clinical application.
引文
[1]荣国威,孟承武.骨折[M].北京：人民卫生出版社,2004：1348.
[2]王继桐.小儿肱骨远端全骺分离8例诊治体会[J].中国中西医结合外科杂志,2000(6)6,3：202.
[3]田代华整理.中医临床必读丛书——黄帝内经素问[M].北京：人民卫生出版社,2007：2.
[4]清·吴谦编,郑金生整理.中医临床必读丛书——医宗金鉴(下)[M].北京：人民卫生出版社2006：679.
[5]田代华整理.中医临床必读丛书——灵枢经[M].北京：人民卫生出版社,2005：15.
[6]潘少川.小儿骨科学[M].北京：人民卫生出版社,2005：442.
[7]张敬东,易先宏,李玉安,等.超声影像在小儿骨折诊断治疗中的价值[C].中华医学会第八次全国小儿外科学术会论文集,2010.
[8]Ziv N, Litwin A, Katz K. Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography[J]. Pediatr Radiol,1996,26:493-496.
[9]王琪,苟三怀,欧阳跃平,等.儿童肱骨远端骺板损伤的诊治[J].中华创伤骨科杂志,2007,11(9)：1006-1008.
[10]王亦璁.骨与关节损伤(第4版)[M].北京：人民卫生出版社,1997.
[11]杨健松.屈肘牵引法整复治疗小儿肱骨远端全骺分离16例[J].上海中医药大学学报,2004,(04).
[12]吴聪.儿童肱骨远端全骺分离疗效的相关因素分析[J].中国现代医生,2010,(06).
[13]武永刚,阿尔宾,宝音,等.闭合整复经皮克氏针固定治疗肱骨远端全骺分离[J].中国骨伤,2002,(03).
[14]李健,杨茂清,张秀娟,等.手法复位经皮穿针内固定治疗儿童肱骨远端全骺分离[J].中国骨伤,2002,(03).
[15]苏继娟,马辉,陈蕾,等.手法复位闭式穿针治疗儿童肱骨远端骨骺分离骨折54例[J].辽宁中医杂志,2003,(12).
[16]de Jager LT, Hoffman EB. Fracture-separation of the distal humeral epiphysis[J]. J Bone Joint Surg Br,1991 Jan,73(1):143-6.
[17]孙成长,陶志东,李光阳,等.肱骨远端全骨骺分离10例手术治疗体会[J].中医正骨,2007,11：58.
[18]陈后平,刘敏,罗启成.儿童肱骨远端骨骺分离的临床诊治研究[J].中华妇幼临床医学杂志：电子版,2009,5(2)：132-135.
[19]Abe M, Ishizu T, Nagaoka T, Onomura T. Epiphyseal separation of the distal end of the humeral epiphysis:a follow-up note[J]. Pediatr Orthop,1995,15(4):426-34.
[20]Takeyasu Y, Murase T, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus[J]. Shoulder Elbow Surg,2011,20,3:440-448.
[21]张德洲,易雪冰,钟鉴,等.儿童肘关节损伤致肘内翻畸形机制探讨[J].中国骨伤,2010,(01).
[22]俞辉国,宋连成,张建华,等.肱骨髁上骨折复位后固定位置的生物力学探讨[J].中华骨科杂志,1989,9(3)：209-211.
[23]尾原敏英,室田景久,富田泰次.小儿腕肱骨髁上骨折（？）治疗成绩一观血的整复术例（？）（？）（？）（？）[J].整形外科,1993,44：465.
[25]OhCW, Park BC, Ihn JC, Kyung HS. Fracture separation of the distal humeral epiphysis in children younger than three years old[J]. J Pediatr Orthop,2000,20(2):173-176.
[26]朱建非,张穹,丁杰,等.儿童肱骨髁上骨折治疗中的肘内翻预防[J].中国骨与关节损伤杂志,2009,(02).
[27]刘国荣,布林白拉乙.创伤后肘关节功能障碍康复训练的疗效观察[J].中国现代医生,2009,9(47).
[28]贾凤荣,周谍望.肘关节骨折术后康复的研究[J].中国康复医学杂志,2005,20(10).
[29]陈湘鄂,周新萍,吴杏香,等.骨折后肘关节功能障碍患者的综合康复治疗[J].武汉大学学报,2008,9(29).
[30]王会同.中药熏洗治疗外伤性肘关节僵硬56例疗效观察[J].中国现代药物应用,2010,10(4).
[31]Lynn T, Staheli潘少川译.实用小儿骨科学(第二版)[M].北京：人民卫生出版社,2007.
[32]王亦璁.骨与关节损伤(第4版)[M].北京：人民卫生出版社,1997.
[33]Modabber MR, Jupiter JB. Reconstruction for post-traumatic condition of the elbow joint[J]. J Bone Joint Surg(AM),1995,77A:1431-1442.
[34]Flynn JC, Matthews JG, Benoyt RL. Blincl pinnimg of clisplaced supracondylar fractures of the humerus in children:sixteen years, experience with long-term follow-up[J]. J Bone Joint Surg(AM),1974,56:263-272.
[35]邹勇根,李伟强,郭跃明,等.早期手术矫形对儿童肱骨髁上骨折后肘内翻畸形的影响[J].岭南现代临床外科,2006(4)
[2]王继桐.小儿肱骨远端全骺分离8例诊治体会[J].中国中西医结合外科杂志,2000(6)6,3：202.
[3]田代华整理.中医临床必读丛书——黄帝内经素问[M].北京：人民卫生出版社,2007：2.
[4]清·吴谦编,郑金生整理.中医临床必读丛书——医宗金鉴(下)[M].北京：人民卫生出版社2006：679.
[5]田代华整理.中医临床必读丛书——灵枢经[M].北京：人民卫生出版社,2005：15.
[6]潘少川.小儿骨科学[M].北京：人民卫生出版社,2005：442.
[7]张敬东,易先宏,李玉安,等.超声影像在小儿骨折诊断治疗中的价值[C].中华医学会第八次全国小儿外科学术会论文集,2010.
[8]Ziv N, Litwin A, Katz K. Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography[J]. Pediatr Radiol,1996,26:493-496.
[9]王琪,苟三怀,欧阳跃平,等.儿童肱骨远端骺板损伤的诊治[J].中华创伤骨科杂志,2007,11(9)：1006-1008.
[10]王亦璁.骨与关节损伤(第4版)[M].北京：人民卫生出版社,1997.
[11]杨健松.屈肘牵引法整复治疗小儿肱骨远端全骺分离16例[J].上海中医药大学学报,2004,(04).
[12]吴聪.儿童肱骨远端全骺分离疗效的相关因素分析[J].中国现代医生,2010,(06).
[13]武永刚,阿尔宾,宝音,等.闭合整复经皮克氏针固定治疗肱骨远端全骺分离[J].中国骨伤,2002,(03).
[14]李健,杨茂清,张秀娟,等.手法复位经皮穿针内固定治疗儿童肱骨远端全骺分离[J].中国骨伤,2002,(03).
[15]苏继娟,马辉,陈蕾,等.手法复位闭式穿针治疗儿童肱骨远端骨骺分离骨折54例[J].辽宁中医杂志,2003,(12).
[16]de Jager LT, Hoffman EB. Fracture-separation of the distal humeral epiphysis[J]. J Bone Joint Surg Br,1991 Jan,73(1):143-6.
[17]孙成长,陶志东,李光阳,等.肱骨远端全骨骺分离10例手术治疗体会[J].中医正骨,2007,11：58.
[18]陈后平,刘敏,罗启成.儿童肱骨远端骨骺分离的临床诊治研究[J].中华妇幼临床医学杂志：电子版,2009,5(2)：132-135.
[19]Abe M, Ishizu T, Nagaoka T, Onomura T. Epiphyseal separation of the distal end of the humeral epiphysis:a follow-up note[J]. Pediatr Orthop,1995,15(4):426-34.
[20]Takeyasu Y, Murase T, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus[J]. Shoulder Elbow Surg,2011,20,3:440-448.
[21]张德洲,易雪冰,钟鉴,等.儿童肘关节损伤致肘内翻畸形机制探讨[J].中国骨伤,2010,(01).
[22]俞辉国,宋连成,张建华,等.肱骨髁上骨折复位后固定位置的生物力学探讨[J].中华骨科杂志,1989,9(3)：209-211.
[23]尾原敏英,室田景久,富田泰次.小儿腕肱骨髁上骨折（？）治疗成绩一观血的整复术例（？）（？）（？）（？）[J].整形外科,1993,44：465.
[25]OhCW, Park BC, Ihn JC, Kyung HS. Fracture separation of the distal humeral epiphysis in children younger than three years old[J]. J Pediatr Orthop,2000,20(2):173-176.
[26]朱建非,张穹,丁杰,等.儿童肱骨髁上骨折治疗中的肘内翻预防[J].中国骨与关节损伤杂志,2009,(02).
[27]刘国荣,布林白拉乙.创伤后肘关节功能障碍康复训练的疗效观察[J].中国现代医生,2009,9(47).
[28]贾凤荣,周谍望.肘关节骨折术后康复的研究[J].中国康复医学杂志,2005,20(10).
[29]陈湘鄂,周新萍,吴杏香,等.骨折后肘关节功能障碍患者的综合康复治疗[J].武汉大学学报,2008,9(29).
[30]王会同.中药熏洗治疗外伤性肘关节僵硬56例疗效观察[J].中国现代药物应用,2010,10(4).
[31]Lynn T, Staheli潘少川译.实用小儿骨科学(第二版)[M].北京：人民卫生出版社,2007.
[32]王亦璁.骨与关节损伤(第4版)[M].北京：人民卫生出版社,1997.
[33]Modabber MR, Jupiter JB. Reconstruction for post-traumatic condition of the elbow joint[J]. J Bone Joint Surg(AM),1995,77A:1431-1442.
[34]Flynn JC, Matthews JG, Benoyt RL. Blincl pinnimg of clisplaced supracondylar fractures of the humerus in children:sixteen years, experience with long-term follow-up[J]. J Bone Joint Surg(AM),1974,56:263-272.
[35]邹勇根,李伟强,郭跃明,等.早期手术矫形对儿童肱骨髁上骨折后肘内翻畸形的影响[J].岭南现代临床外科,2006(4)
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