镜下与开放复位治疗儿童肱骨外髁骨折的比较

Comparison of arthroscopic versus open reduction and internal fixation of lateral humeral condylar fracture in children

摘要:

[目的] 比较镜下与开放复位治疗儿童肱骨外髁骨折的临床疗效。[方法] 回顾性分析2019 年12 月—2021 年12 月在青岛市妇女儿童医院治疗的肱骨外髁骨折101 例患儿的临床资料，根据医患沟通结果，70 例采取镜下复位内固定，另外31例采取开放复位内固定。比较两组围术期、随访及影像资料。[结果] 两组患儿均顺利手术。镜下组手术时间[(45.6±8.6) min vs(53.7±10.6) min, P＜0.001]、切口总长度[(1.5±0.3) cm vs (4.7±0.6) cm, P＜0.001]、住院时间[(5.1±0.8) d vs (6.8±1.0) d, P＜0.001] 均优于开放组，但前者术中透视次数显著多于后者[(12.0±2.0) 次vs (10.5±2.5) 次, P=0.002]，两组切口愈合等级的差异无统计学意义（P＞0.05）。两组均获得12 个月以上随访，镜下组取钉时间显著早于开放组[(67.3±8.2) d vs (80.5±12.5) d, P＜0.001]。与取钉术后3 个月相比，末次随访时两组患儿MEPS 均无显著变化（P＜0.05），两组患儿VAS 评分均显著下降（P＜0.05），但相应时间点两组间上述评分的差异均无统计学意义（P＞0.05）。镜下组在取钉术后3 个月的前臂旋前-旋后ROM 优于开放组[(173.6±10.0)° vs(166.6±10.1)°, P=0.002]。影像方面，镜下组骨折复位质量显著优于开放组（P＜0.05）。与术后即刻相比，末次随访时镜下组和开放组的BA 增大（P＜0.05），但两组的CA 和ADH 均无显著变化（P＞0.05）。[结论] 镜下复位治疗儿童肱骨外髁骨折，切口小，临床疗效确切，无严重并发症发生，在熟练掌握后可成为治疗儿童肱骨外髁骨折的新选择。

Abstract:

[Objective] To compare the clinical efficacy of arthroscopic versus open reduction and internal fixation of lateral humeruscondylar fracture in children. [Methods] A retrospective study was conduced on 101 children who received surgical treatment for lateral hu-meral condylar fracture in Qingdao Women and Children's Hospital from December 2019 to December 2021. According to doctor-patientcommunication, 70 children received arthroscopic reduction and internal fixation (ARIF), while the other 31 children received open reduc-tion and internal fixation (ORIF). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients inboth group had corresponding surgical operations performed successfully. The ARIF group proved significantly superior to the ORIF groupin terms of operation time [(45.6±8.6) min vs (53.7±10.6) min, P＜0.001], total length of incision, [(1.5±0.3) cm vs (4.7±0.6) cm, P＜0.001]and hospital stay [(5.1±0.8) days vs (6.8±1.0) days, P＜0.001], whereas the former consumed significantly greater number of intraoperativefluoroscopy than the latter [(12.0±2.0) times vs (10.5±2.5) times, P=0.002], and there was no statistically significant difference in incisionhealing grade between the two groups (P＞0.05). All patients in both groups were followed up for more than 12 months, and the ARIF grouphad K-wire removed significantly earlier than the ORIF group [(67.3±8.2) days vs (80.5±12.5) days, P＜0.001]. Compared with those 3months after K-wire removed, MEPS remained unchanged (P＞0.05), while VAS scores significantly decreased in both groups at the latestfollow up (P＜0.05), but there were no statistically significant differences in the above scores between the two groups at any correspondingtime points (P＞0.05). In addition, the ARIF group was significantly better than the ORIF in forearm pronation-supination ROM 3 months af-ter K-wire removed [(173.6±10.0)° vs (166.6±10.1)°, P=0.002]. Regarding imaging, the ARIF group got significant better quality of fracturereduction than the ORIF group (P＜0.05). At the last follow-up the Baumann angle (BA) increased significantly in both groups (P＜0.05),while the carrying angle (CA) and anterior angulation of distal humerus (ADH) were not significantly changed in both groups (P＞0.05).[Conclusion] Arthroscopic reduction and internal fixation have advantages of less incision and less serious complications, and could be a

new choice for lateral humerus condyle fracture in children.