CAJ | 학술논문

目的比较应用克氏针操纵复位与有限切开复位技术在弹性髓内钉固定治疗儿童股骨干骨折的疗效.方法回顾性分析2006年1月至201 1年10月47例采用弹性髓内钉固定治疗的股骨干骨折患儿的病例资料,按手术复位方式分为2组,A组25例采用克氏针操纵复位,B组22例采用有限切开复位.收集所有患儿的临床和影像学资料,比较2组患儿的年龄、性别、受伤至手术时间、随访时间、骨折分型、术中出血量、手术时间、X线曝光次数、住院时间、术后负重时间、骨折愈合时间、并发症情况、末次随访时髋关节Harris评分及美国特种外科医院膝关节评分(HSS评分)结果.结果 47例患儿术后平均随访21个月(18～23个月).2组患儿年龄、性别、受伤至手术时间、随访时间、骨折分型、X线曝光次数、下地负重时间、骨折愈合时间、末次随访髋关节Harris评分和膝关节HSS评分比较,差异均无统计学意义(P均＞0.05).克氏针操纵复位组与有限切开复位组的术中出血量分别为(5.0±1.3)mL和(17.4±4.1) mL,手术时间为(40.0±4.8) min和(51.4±9.4) min,住院时间为(6.5±1.7)d和(12.5±2.4)d,术后切口疼痛为2例和8例,2组比较差异均有统计学意义(t=-13.600、-4.936、-9.052,x2=6.112,P均＜0.05).结论在弹性髓内钉固定治疗儿童股骨干骨折中,有限切开复位技术与克氏针操纵复位在骨折愈合时间与功能评定方面差异无统计学意义.但克氏针操纵复位技术术中出血少、住院时间短、并发症少,是一种较为理想的复位选择.
목적 비교응용극씨침조종복위여유한절개복위기술재탄성수내정고정치료인동고골간골절적료효.방법 회고성분석2006년1월지201 1년10월47례채용탄성수내정고정치료적고골간골절환인적병례자료,안수술복위방식분위2조,A조25례채용극씨침조종복위,B조22례채용유한절개복위.수집소유환인적림상화영상학자료,비교2조환인적년령、성별、수상지수술시간、수방시간、골절분형、술중출혈량、수술시간、X선폭광차수、주원시간、술후부중시간、골절유합시간、병발증정황、말차수방시관관절Harris평분급미국특충외과의원슬관절평분(HSS평분)결과.결과 47례환인술후평균수방21개월(18～23개월).2조환인년령、성별、수상지수술시간、수방시간、골절분형、X선폭광차수、하지부중시간、골절유합시간、말차수방관관절Harris평분화슬관절HSS평분비교,차이균무통계학의의(P균＞0.05).극씨침조종복위조여유한절개복위조적술중출혈량분별위(5.0±1.3)mL화(17.4±4.1) mL,수술시간위(40.0±4.8) min화(51.4±9.4) min,주원시간위(6.5±1.7)d화(12.5±2.4)d,술후절구동통위2례화8례,2조비교차이균유통계학의의(t=-13.600、-4.936、-9.052,x2=6.112,P균＜0.05).결론 재탄성수내정고정치료인동고골간골절중,유한절개복위기술여극씨침조종복위재골절유합시간여공능평정방면차이무통계학의의.단극씨침조종복위기술술중출혈소、주원시간단、병발증소,시일충교위이상적복위선택.
Objective To evaluate the effectiveness and clinical outcomes in pediatric femoral shaft fractures treated with flexible intramedullary nailing,with percutaneous joystick reduction versus limited open reduction.Methods This retrospective comparative study was analyzed in a total of 47 pediatric femoral shaft fractures treated with flexible intramedullary nailing from Jan.2006 to Oct.2011.Twenty-five cases were percutaneous reduction using the K-wire pin as joystick,and 22 cases were treated with limited open reduction.The clinical and radiographic data including the age,sex,time from injury to surgery,follow-up time,fracture types,operation time,volume of bleeding,X-ray exposure times,hospitalization,postoperative weight-bearing time,healing time,complications,Harris score and Hospital for Special Surgery knee score(HSS score) at the final follow-up were collected and compared in both surgical groups.Results All patients were postoperatively followed up for 18-23 months with an average of 21 months.The age,sex,time from injury to surgery,follow-up time,fracture types,X-ray exposure times,postoperative weight-bearing time,healing time,Harris score and HSS score at the last follow-up were not statistically different(all P ＞ 0.05).The blood loss [(5.0 ± 1.3) mL vs (17.4 ±4.1) mL],operative time[(40.0 ±4.8) min vs (51.4 ±9.4) min],hospital stay[(6.5 ± 1.7) days vs (12.5 ±2.4) days] and postoperative incision pain(2 cases vs 8 cases) were all significantly less in the percutaneous joystick reduction than limited open reduction group (t =-13.600,-4.936,-9.052,x2 =6.112,all P ＜ 0.05).Conclusions Compared with limíted open reduction,the percutaneous joystick reduction significantly reduced bleeding,operation time,hospitalization and complications and can be considered as a useful reduction technique in the treatment of pediatric femoral shaft fractures with flexible intramedullary nailing.