切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 95 -102. doi: 10.3877/cma.j.issn.1674-0785.2021.02.003

所属专题: 骨科学 文献

临床研究

儿童开放性肱骨髁上骨折与Gartland Ⅲ型肱骨髁上骨折的临床治疗效果
张福勇1, 王晓东1,(), 甄允方1, 郭志雄1, 戴进1, 方建峰1, 袁泉文1, 宿广昊1, 朱伦庆1, 祝振华1   
  1. 1. 215000 江苏苏州,苏州大学附属儿童医院骨科
  • 收稿日期:2020-08-17 出版日期:2021-02-15
  • 通信作者: 王晓东
  • 基金资助:
    江苏省青年医学人才项目资助(2017757)

Closed versus open supracondylar fractures of the humerus in children: a comparison of therapeutic effect

Fuyong Zhang1, Xiaodong Wang1,(), Yunfang Zhen1, Zhixiong Guo1, Jin Dai1, Jianfeng Fang1, Quanwen Yuan1, Guanghao Su1, Lunqing Zhu1, Zhenhua. Zhu1   

  1. 1. Department of Pediatric Orthopedics, Children's Hospital of Soochow University, Suzhou 215000, China
  • Received:2020-08-17 Published:2021-02-15
  • Corresponding author: Xiaodong Wang
引用本文:

张福勇, 王晓东, 甄允方, 郭志雄, 戴进, 方建峰, 袁泉文, 宿广昊, 朱伦庆, 祝振华. 儿童开放性肱骨髁上骨折与Gartland Ⅲ型肱骨髁上骨折的临床治疗效果[J/OL]. 中华临床医师杂志(电子版), 2021, 15(02): 95-102.

Fuyong Zhang, Xiaodong Wang, Yunfang Zhen, Zhixiong Guo, Jin Dai, Jianfeng Fang, Quanwen Yuan, Guanghao Su, Lunqing Zhu, Zhenhua. Zhu. Closed versus open supracondylar fractures of the humerus in children: a comparison of therapeutic effect[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(02): 95-102.

目的

比较儿童开放性与Gartland Ⅲ型肱骨髁上骨折的临床治疗效果,探讨儿童开放性肱骨髁上骨折的治疗方法。

方法

回顾性分析2011年6月至2019年6月我院收治并随访的19例开放性肱骨髁上骨折患儿,随机筛选同期的38例Gartland Ⅲ型肱骨髁上骨折患儿,比较两者的临床治疗结果。开放性肱骨髁上骨折患儿入院后及早静脉滴注抗生素。Gustilo Ⅲ型及Ⅱ型儿童开放性肱骨髁上骨折行急诊手术治疗,Gustilo Ⅰ型儿童开放性肱骨髁上骨折予以局部消毒包扎、手法复位及石膏临时固定,行急诊或亚急诊手术治疗。Gartland Ⅲ型肱骨髁上骨折均行手法复位及石膏临时固定,限期内手术治疗。比较术前住院时间、合并损伤情况、手术时间、术后感染及术后功能恢复等。

结果

两组患儿的年龄、性别没有显著性差异,术后随访时间6~27个月,平均19个月。Gustilo Ⅰ型儿童开放性肱骨髁上骨折手术时间平均为(35.18±4.67)min,Gartland Ⅲ型肱骨髁上骨折手术时间平均为(40.77±2.68)min,差异无统计学差异(P=0.273);Gustilo Ⅱ型骨折手术时间平均为(41.25±5.15)min,较Gartland Ⅲ型肱骨髁上骨折手术时间长,但差异无统计学意义(P=0.063);Gustilo Ⅲ型骨折手术时间为1~6 h,平均(200.00±61.64)min,较Gartland Ⅲ型肱骨髁上骨折手术时间长,差异有统计学意义(P=0.037)。Gartland Ⅲ型肱骨髁上骨折术后感染率为2.6%,开放性肱骨髁上骨折患儿术后感染发生率为5.3%,差异无统计学意义(χ2=0.259,P=0.611)。Gartland Ⅲ型肱骨髁上骨折患儿神经损伤发生率为28.9%,开放性肱骨髁上骨折患儿神经损伤发生率为42.1%,差异无统计学意义(χ2=0.987,P=0.321),所有神经损伤病例随访6个月均恢复。末次随访时Flynn评分:Gartland Ⅲ型肱骨髁上骨折患儿优36例(94.7%),良2例(5.3%);开放性骨折患儿优16例(84.2%),良3例(15.8%);两者差异无统计学意义(χ2=1.754,P=0.185)。

结论

儿童开放性肱骨髁上骨折在经过抗菌药物治疗、软组织清创、骨折有效固定等确切治疗后,与Gartland Ⅲ型肱骨髁上骨折相比,总体治疗效果相似。

Objective

To compare the presentation and postoperative results of children treated for open and Gartland type Ⅲ supracondylar fractures of the humerus.

Methods

From June 2011 to June 2019, 19 patients with open and 38 patients with Gartland type Ⅲ supracondylar fractures of the humerus were evaluated. Intravenous antibiotics were used for open supracondylar fracture patients as early as possible. Patients with Gustilo types Ⅲ and Ⅱ open supracondylar fracture of the humerus were treated by emergency operation. Gustilo type Ⅰ open supracondylar fracture patients were treated by disinfection, bandage, reduction, temporary plaster fixation, emergency or sub emergency operation. Gartland type Ⅲ supracondylar fracture patients were treated by reduction, temporary plaster fixation, and operation within the time limit. The wound characteristics, combined injuries, operation timing, operation time, clinical efficacy, and complications were analyzed.

Results

The two groups were similar with respect to age and sex. All the patients were followed for 6-27 months, with an average of 19 months. The mean operative time of Gustilo type Ⅰ patients was (35.18±4.67) min, and that of Gartland type Ⅲ patients was (40.77±2.68) min; the difference between them was not statistically significant (P=0.273). The mean operative time of Gustilo type Ⅱ patients was (41.25±5.15) min, which was longer than that of Gartland type Ⅲ patients, but with no statistically significant difference (P=0.063). The mean operative time of Gustilo type Ⅲ patients was (200.00±61.64) min, which was longer than that of Gartland type Ⅲ patients (P=0.037). The incidence of postoperative infection was 5.3% in open fracture patients and 2.6% in Gartland type Ⅲ patients, and the difference between them was not statistically significant (χ2=0.259, P=0.611). The incidence of nerve injury was 28.9% in Gartland type Ⅲ patients and 42.1% in open fracture patients, and there was no significant difference between them (χ2=0.987, P=0.321). At the last follow-up, 36 cases (94.7%) achieved excellent results and 2 cases (5.3%) achieved good results in Gartland type Ⅲ patients and the corresponding figures in open fracture patients were 16 (84.2%) and 3 (15.8%), respectively, there was no significant difference between them (χ2=1.754, P=0.185).

Conclusion

Open supracondylar fracture of the humerus in children can be cured with antibiotics, timely debridement, and effective fixation. The treatment effect of open supracondylar fractures of the humerus in children is similar to that of Gartland type Ⅲ supracondylar fractures. The therapeutic effect is excellent.

表1 19例开放性肱骨髁上骨折患儿一般资料、手术时间及术后功能评价
表2 开放性肱骨髁上骨折与Gartland Ⅲ型肱骨髁上骨折患儿的治疗评价
图1 右侧开放性肱骨髁上骨折患儿术前正侧位X线片。图a为术前正位片;图b为术前侧位片
图2 右侧开放性肱骨髁上骨折患儿外观照。图a为术前外观照,骨折近侧断端刺出皮肤;图b为术中探查见右侧肱动静脉断裂,肱动静脉吻合后外观照
图3 右侧开放性肱骨髁上骨折患儿术后1个月复查肘关节正侧位X线片。图a为正位片;图b为侧位片
图4 右侧开放性肱骨髁上骨折患儿术后27个月复查肘关节正侧位X线片。图a为正位片;图b为侧位片
图5 右侧开放性肱骨髁上骨折患儿术后27个月肘关节外观照,功能恢复好。图a为右侧肘关节提携角与对侧相仿;图b为右侧肘关节屈曲功能与对侧相同;图c为右侧肘关节伸直功能与对侧相同
1
Pace JL, Kocher MS, Skaggs DL. Evidence-based review: management of open pediatric fractures [J]. J Pediatr Orthop, 2012, 32: S123-S127.
2
Havránek P, Pesl T, Hendrych J, et al. Supracondylar fracture of the humerus in childhood [J]. Rozhl Chir, 2018, 97(3): 122-127.
3
Lewine E, Kim JM, Miller PE, et al. Closed versus open supracondylar fractures of the humerus in children: a comparison of clinical and radiographic presentation and results [J]. J Pediatr Orthop, 2018, 38(2): 77-81.
4
Kim PH, Leopold SS. Gustilo-Anderson classification [J]. Clin Orthop Relat Res, 2012, 470(11): 3270-3274.
5
Roberts CS, Adams EL. The classification of open fractures: are we there yet? [J]. Injury, 2013, 44(4): 403-405.
6
Frick SL, Mehlman CT. The community orthopaedic surgeon taking trauma call: pediatric supracondylar humeral fracture pearls and pitfalls [J]. J Orthop Trauma, 2017, 31 Suppl 6: S11-S15.
7
冯超,郭源,张建立. 克氏针治疗儿童肱骨髁上骨折的穿针方式效果分析 [J]. 中华小儿外科杂志, 2008, 29(5): 291-293.
8
曾裴, 杨建平. 儿童闭合性Gartland Ⅲ型肱骨髁上骨折合并血管神经损伤的治疗 [J]. 中华创伤骨科杂志, 2013, 15(4): 352-354.
9
Halvorson J, Jinnah, Kulp B, et al. Use of vacuum assisted closure in pediatric open fractures with a focus on the rate of infection [J]. Orthopedics, 2011, 34(7): e256-e260.
10
Contractor D, Amling J, Brandoli C, et al. Negative pressure wound therapy with reticulated open cell foaln in children: an overview [J]. J Orthop Trauma, 2008, 22(10 Suppl): S167-S176.
11
Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children: sixteen years' experience with long-term follow up [J]. J Bone Joint Surg Am, 1974, 56(2):263-272.
12
文玉伟, 王强. 儿童肱骨髁上骨折的诊疗进展 [J]. 中华小儿外科杂志, 2017, 38(5): 390-394.
13
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses [J]. J Bone Joint Surg Am, 1976, 58(4): 453-458.
14
Fumival RA, Schunk JE. ABCs of scoring systems for peditrie trauma [J]. Pediatr Emerg Care, 1999, 15(3): 215.
15
Hauser CJ, Adams CA, Eachempati SR. Surgical infection society guideline. prophylactic antibiotic use in open fractures: an evidence based guideline [J]. Surg Infect, 2006, 7(4): 379-405.
16
Nirav KP. Flexible intramedullary nailing of unstable and/or open tibia shaft fractures in the pediatric population [J]. J Pediatr Orthop, 2016, 36 Suppl 1: S19-S23.
17
Skaggs DL, Friend L, Alman B, et al. The effect of surgical delay on acute infection following 554 open fractures in children [J]. J Bone Joint Surg Am, 2005, 87(A): 8-12.
18
孙亮, 刘万林, 韦宜山, 等. 半无菌技术在闭合复位经皮克氏针内固定治疗儿童肱骨髁上骨折中的应用 [J]. 中华小儿外科杂志, 2019, 40(6): 536-539.
19
McKeon KE, O'Donnell JC, Bashyal R, et al. Immobilization after pinning of supracondylar distal humerus fractures in children: use of the A-frame cast [J]. J Pediatr Orthop, 2012, 32(1): e1-5.
[1] 陶宏宇, 叶菁菁, 俞劲, 杨秀珍, 钱晶晶, 徐彬, 徐玮泽, 舒强. 右心声学造影在儿童右向左分流相关疾病中的评估价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 959-965.
[2] 刘琴, 刘瀚旻, 谢亮. 基质金属蛋白酶在儿童哮喘发生机制中作用的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 564-568.
[3] 向韵, 卢游, 杨凡. 全氟及多氟烷基化合物暴露与儿童肥胖症相关性研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 569-574.
[4] 郭杰坤, 王楹, 杨轩, 晏欢欣, 钟豪. Ilizarov 骨搬移技术在急诊一期修复GustiloⅢB 型胫骨长段开放粉碎性骨折的临床效果[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 507-510.
[5] 张梦思, 麻艺群, 蒙礼娟, 朱辉, 付晋凤. 压力手套与指蹼加压带及泡沫型硅凝胶贴膜联合应用于儿童瘢痕性并指术后的效果观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(04): 329-334.
[6] 郑宝英, 黄小兰, 贾楠, 朱春梅. 儿童难治性肺炎支原体肺炎早期预警指标[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 215-221.
[7] 刘冉佳, 崔向丽, 周效竹, 曲伟, 朱志军. 儿童肝移植受者健康相关生存质量评价的荟萃分析[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 302-309.
[8] 丁荷蓓, 王珣, 陈为国. 七氟烷吸入麻醉与异丙酚静脉麻醉在儿童腹股沟斜疝手术中的应用比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 570-574.
[9] 曾纪晓, 徐晓钢, 王欣星, 刘斐, 兰梦龙, 陶波圆, 梁子建, 叶志华, 罗媛圆. 达芬奇机器人辅助Swenson-like巨结肠根治术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 239-243.
[10] 中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.
[11] 刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[12] 张佳臣, 宋红欣. 儿童青少年等效球镜屈光度变化与屈光不正进展相关性的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(04): 217-222.
[13] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[14] 陈晓胜, 何佳, 刘方, 吴蕊, 杨海涛, 樊晓寒. 直立倾斜试验诱发31 秒心脏停搏的植入心脏起搏器儿童一例并文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 488-494.
[15] 曹亚丽, 高雨萌, 张英谦, 李博, 杜军保, 金红芳. 儿童坐位不耐受的临床进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 510-515.
阅读次数
全文


摘要