悬吊固定联合铰链外固定支架与双钢板内固定治疗肱骨髁间C型骨折疗效比较

发布时间：2018-03-17 01:36

本文选题：肱骨髁间骨折　切入点：克氏针　出处：《中国修复重建外科杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的比较克氏针加钢丝悬吊固定联合铰链外固定支架与双钢板内固定治疗肱骨髁间C型骨折患者的疗效差异。方法以2014年1月—2016年4月,收治并符合选择标准的30例国际内固定研究协会(AO/ASIF)分型为C型的肱骨髁间骨折患者为研究对象。其中14例采用克氏针加钢丝悬吊固定联合铰链外固定支架固定治疗(A组),16例采用双钢板内固定治疗(B组)。两组患者性别、年龄、致伤原因、受伤至手术时间、骨折侧别及类型等一般资料比较,差异均无统计学意义(P0.05),具有可比性。结果两组手术时间、住院时间比较差异无统计学意义(P0.05);但A组术中出血量较B组少,术后第1、3天疼痛视觉模拟评分(VAS)优于B组,差异有统计学意义(P0.05)。术后两组切口均Ⅰ期愈合,无相关并发症发生。两组患者均获随访,A组随访时间6~24个月,平均12.3个月;B组6~24个月,平均12.8个月。A组患者术后3个月取外固定支架时,患者自评满意度满意率为85.7%(12/14),B组同时间点满意率为81.2%(13/16),比较差异无统计学意义(χ2=0.055,P=0.990)。术后6个月参照改良Gassebaum评分系统评价肘关节功能,A组优5例、良6例、可2例、差1例,优良率为78.6%;B组优6例、良7例、可2例、差1例,优良率为81.2%;两组优良率比较差异无统计学意义(χ2=0.056,P=0.990)。术后3个月随访时A、B组各出现1例异位骨化。X线片复查示,A、B组无内固定物松动及断裂发生;骨折均达骨性愈合,且两组骨折愈合时间比较差异无统计学意义(t= 0.028,P=0.978)。两组骨折愈合后均行二次手术取出内固定物;A组内固定物取出术手术时间、术中出血量以及术后第1、3天VAS评分均优于B组,比较差异有统计学意义(P0.05)。结论对于肱骨髁间C型骨折,克氏针加钢丝悬吊固定联合铰链外固定支架以及双钢板内固定方法治疗均可获得较理想的肘关节功能,但前者在术中出血量、术后疼痛评分以及取出内固定物手术时间、术中出血量及术后疼痛评分方面具有优势。
[Abstract]:Objective to compare the curative effect of Kirschner's needle and steel wire suspension fixation combined with hinge external fixator and double plate internal fixation in the treatment of humeral intercondylar type C fracture. Thirty patients with type C humeral intercondylar fracture classified by AOP / ASIFF were treated with Kirschner's needle and steel wire suspension fixation combined with hinge external fixator. In group A, 16 cases were treated with double plate internal fixation. There were no significant differences in age, cause of injury, time from injury to operation, fracture side and type, etc. There was no significant difference between the two groups (P 0.05). Results there was no significant difference between the two groups in operation time. There was no significant difference in hospitalization time between group A and group B, but the amount of intraoperative bleeding in group A was less than that in group B, and the visual analogue score of pain in group A was better than that in group B on the 1st day after operation, and the difference was statistically significant (P 0.05). There were no related complications. All the patients in group A were followed up for 624 months (mean 12.3 months, mean 12.8 months), and the patients in group A were treated with external fixation stents 3 months after operation. The satisfaction rate at the same time in group B was 81.22 / 16. There was no significant difference (蠂 ~ 20.055P ~ (0.990)). Six months after operation, 5 cases were excellent, 6 cases were good, 2 cases were fair, and 1 case was poor according to the modified Gassebaum scoring system. The excellent and good rate was 78.6% in group B: excellent in 6 cases, good in 7 cases, fair in 2 cases, and poor in 1 case. The excellent and good rate was 81.2. There was no significant difference in the excellent and good rates between the two groups (蠂 ~ 2 / 0. 056 / P ~ (0.990)). After 3 months of follow-up, 1 case of ectopic ossification appeared in group A (n = 1). X-ray examination showed that there was no loosening and breaking of internal fixation in group A (n = 1), and the fracture was bony healing. There was no significant difference in fracture healing time between the two groups (t = 0.028 P0. 978). The time of removal of internal fixator in group A was better than that in group B after fracture healing. The amount of intraoperative bleeding and the score of VAS on the 1st day after operation were better than those in group B. Conclusion for humeral intercondylar C type fracture, Kirschner's needle and steel wire suspension fixation combined with hinge external fixator and double plate internal fixation can achieve better elbow joint function. However, the former had advantages in the amount of intraoperative bleeding, postoperative pain score, the time of removal of internal fixation, the amount of intraoperative bleeding and the postoperative pain score.
【作者单位】：自贡市第四人民医院骨一科;
【分类号】：R687.32

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