不同方式治疗儿童新鲜孟氏骨折的疗效分析
发布时间：2018-11-10 18:27
【摘要】：目的探讨儿童新鲜孟氏骨折的闭合手法复位石膏外固定、尺骨切开复位钢板内固定以及单枚克氏针固定肱桡关节加尺骨切开复位钢板内固定三种治疗方法的疗效分析,为该疾病的诊治提供更好的诊疗技术、理论基础及相关依据,以提高儿童新鲜孟氏骨折的临床治愈疗效。方法本文通过收集郑州大学第一附属医院骨外科2014年11月至2017年1月收治的48例患儿资料,并对所有资料进行回顾性研究分析,以探讨其临床疗效。将这48例新鲜孟氏骨折患儿依据治疗方式分为A、B、C三组,每组各16例,A组患儿采用闭合手法复位石膏外固定,B组采用尺骨切开复位钢板内固定治疗,C组采用单枚克氏针固定肱桡关节加尺骨切开复位钢板内固定。术后随访6~24个月(平均12个月),通过对照三组治疗方式患儿年龄性别、分型、骨折愈合时间,得出结果;依据Mayo肘关节功能评分系统得到三组治疗方式优良率及脱位率;随访中测量患儿患侧肘关节屈伸(f/e)、旋转(p/s)范围度,并测量对侧肘关节屈伸(f/e)、旋转(p/s)范围度,将得到的数据进行统计学分析,得出结果;根据肘关节功能评价法(JOA)计算肘关节功能得分,并进行统计学分析,得出结果。应用SPSS20.0统计软件对结果进行统计分析,检验水准α=0.05。结果术后所有患儿均获得6~24个月(平均12个月)的随访,随访期间所有患儿无其他损伤及死亡情况。对这三个组的数据进行回顾性研究分析,三组治疗方式在年龄性别、分型、骨折愈合时间差异无统计学意义(P0.05)。三种治疗方式术后肘关节功能评分优良率及脱位率差异有统计学意义(P0.05);通过观察三组患儿治疗后患侧及健侧伸屈范围度和前臂旋转范围度,得出A组及B组分别在旋转范围和屈伸范围与健侧差异有统计学意义;C组屈伸及旋转范围与健侧差异无统计学意义;根据活动范围度分别计算出功能得分,得出三组治疗方式肘关节功能得分与健侧均无统计学差异(P0.05)。结论A、B、C三组治疗方式在治疗后愈合时间无差别,但C组肘关节优良率高于A、B两组,而通过脱位率证明利用克氏针固定肱桡关节(C组)可更好预防术后桡骨小头脱位;A、B、C三组治疗方式在治疗后肘关节功能得分与健侧并无差异,但A组及B组患儿治疗后肘关节较健侧比较分别有旋转和屈伸功能障碍,C组治疗后患儿肘关节活动度与健侧无差异,术后屈伸、旋转功能均愈合佳;综上所述,单枚克氏针固定肱桡关节加尺骨切开复位钢板内固定治疗方式在术后肘关节屈伸、前臂旋前旋后及肘关节功能方面均疗效显著,优良率高且可预防术后桡骨小头脱位,在临床中可作为治疗儿童新鲜孟氏骨折的首选方法。
[Abstract]:Objective to investigate the curative effect of closed manual reduction and plaster external fixation, open reduction and internal fixation of ulnar plate and single Kirschner needle fixation of brachioradial joint and open reduction plate of ulnar bone in children with fresh Monteggia fracture. To provide better diagnosis and treatment technology, theoretical basis and relevant basis for the diagnosis and treatment of the disease, in order to improve the clinical curative effect of fresh Monteggia fracture in children. Methods from November 2014 to January 2017, 48 cases of children in the Department of Bone surgery of the first affiliated Hospital of Zhengzhou University were collected and analyzed retrospectively. According to the treatment, 48 cases of fresh Monteggia fracture were divided into three groups: group A (n = 16) and group B (n = 16). Group A was treated with closed manipulative reduction and plaster external fixation, group B was treated with open reduction of ulna and internal fixation with plate. In group C, single Kirschner needle was used to fix brachioradial joint and ulnar open reduction plate. The patients were followed up for 6 ~ 24 months (mean 12 months), and the results were obtained by comparing the three treatment methods: age, sex, classification, fracture healing time, and the excellent and good rate and dislocation rate of the three groups were obtained according to the Mayo elbow joint function scoring system. The range of elbow flexion and extension (f / r e), rotation (p / s), contralateral elbow flexion and extension (f / e), rotation (p / s) were measured during follow-up. According to the elbow function evaluation method (JOA) to calculate the elbow joint function score, and carries on the statistical analysis, obtains the result. The results were analyzed by SPSS20.0 software, and the test level was 伪 = 0.05. Results all the children were followed up for 6 ~ 24 months (mean 12 months). The data of the three groups were analyzed retrospectively. There was no significant difference between the three groups in age sex type fracture healing time (P0.05). The excellent and good rate of elbow joint function score and dislocation rate were significantly different between the three treatment methods (P0.05). By observing the range of extension and flexion and the degree of rotation of forearm after treatment, the results showed that the range of rotation and flexion and extension of group A and group B were significantly different from those of healthy side. In group C, there was no significant difference between flexion, extension and rotation range and healthy side. According to the range of activities, the functional score of elbow joint in group C was calculated, and no significant difference was found between the functional score of elbow joint and healthy side in three groups (P0.05). Conclusion there is no difference in healing time among the three groups, but the excellent and good rate of elbow joint in group C is higher than that in group A and B. The dislocation rate showed that Kirschner's needle fixation of the brachioradial joint (group C) was a better way to prevent the dislocation of the radial head after operation. There was no significant difference in elbow function between group A and group B after treatment, but there were rotation and flexion and extension dysfunction of elbow after treatment in group A and group B, respectively. In group C, there was no difference between elbow motion and normal side after treatment, and the function of flexion and extension and rotation healed well after operation. To sum up, single Kirschner needle fixation of brachioradial joint and open reduction of ulnar plate is effective in elbow joint flexion and extension, forearm pronation and elbow joint function. The excellent and good rate is high and can prevent the dislocation of the radial head after operation. It can be used as the first choice in the treatment of fresh Monteggia fracture in children.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8
本文编号：2323256
[Abstract]:Objective to investigate the curative effect of closed manual reduction and plaster external fixation, open reduction and internal fixation of ulnar plate and single Kirschner needle fixation of brachioradial joint and open reduction plate of ulnar bone in children with fresh Monteggia fracture. To provide better diagnosis and treatment technology, theoretical basis and relevant basis for the diagnosis and treatment of the disease, in order to improve the clinical curative effect of fresh Monteggia fracture in children. Methods from November 2014 to January 2017, 48 cases of children in the Department of Bone surgery of the first affiliated Hospital of Zhengzhou University were collected and analyzed retrospectively. According to the treatment, 48 cases of fresh Monteggia fracture were divided into three groups: group A (n = 16) and group B (n = 16). Group A was treated with closed manipulative reduction and plaster external fixation, group B was treated with open reduction of ulna and internal fixation with plate. In group C, single Kirschner needle was used to fix brachioradial joint and ulnar open reduction plate. The patients were followed up for 6 ~ 24 months (mean 12 months), and the results were obtained by comparing the three treatment methods: age, sex, classification, fracture healing time, and the excellent and good rate and dislocation rate of the three groups were obtained according to the Mayo elbow joint function scoring system. The range of elbow flexion and extension (f / r e), rotation (p / s), contralateral elbow flexion and extension (f / e), rotation (p / s) were measured during follow-up. According to the elbow function evaluation method (JOA) to calculate the elbow joint function score, and carries on the statistical analysis, obtains the result. The results were analyzed by SPSS20.0 software, and the test level was 伪 = 0.05. Results all the children were followed up for 6 ~ 24 months (mean 12 months). The data of the three groups were analyzed retrospectively. There was no significant difference between the three groups in age sex type fracture healing time (P0.05). The excellent and good rate of elbow joint function score and dislocation rate were significantly different between the three treatment methods (P0.05). By observing the range of extension and flexion and the degree of rotation of forearm after treatment, the results showed that the range of rotation and flexion and extension of group A and group B were significantly different from those of healthy side. In group C, there was no significant difference between flexion, extension and rotation range and healthy side. According to the range of activities, the functional score of elbow joint in group C was calculated, and no significant difference was found between the functional score of elbow joint and healthy side in three groups (P0.05). Conclusion there is no difference in healing time among the three groups, but the excellent and good rate of elbow joint in group C is higher than that in group A and B. The dislocation rate showed that Kirschner's needle fixation of the brachioradial joint (group C) was a better way to prevent the dislocation of the radial head after operation. There was no significant difference in elbow function between group A and group B after treatment, but there were rotation and flexion and extension dysfunction of elbow after treatment in group A and group B, respectively. In group C, there was no difference between elbow motion and normal side after treatment, and the function of flexion and extension and rotation healed well after operation. To sum up, single Kirschner needle fixation of brachioradial joint and open reduction of ulnar plate is effective in elbow joint flexion and extension, forearm pronation and elbow joint function. The excellent and good rate is high and can prevent the dislocation of the radial head after operation. It can be used as the first choice in the treatment of fresh Monteggia fracture in children.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8
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