【作者】 黎力昊；

【导师】 郭跃明；

【作者基本信息】 广州中医药大学 ， 中医学， 2012， 硕士

【摘要】 目的：阐述小儿肱骨远端全骺分离的治疗研究进展,评价手法复位闭合克氏针内固定治疗小儿肱骨远端全骺分离的临床疗效,分析影响疗效的因素,为肱骨远端全骺分离治疗方案的选择提供临床依据。方法：回顾性分析40例符合纳入标准的肱骨远端全骺分离病例,分成手法复位闭合克氏针内固定(治疗组)和切开复位内固定(对照组)各20例,通过查阅病历及术后随访,分别观察两组的骨折临床愈合时间、分析术后6个月、12个月、18个月影像学资料(Baumann角、提携角),观察记录各种并发症诸如肘内翻畸形、骨折不愈合、神经血管损伤、治疗期间内固定松动退针、针口感染的发生情况等,进行统计学分析。采用Mayo肘关节评分、Flynn评价标准对术后关节功能及肘内翻情况进行评价。成果：对两组患者术后均采用Mayo肘关节评分,治疗组优良率85%,对照组优良率75%,有显著性差异(P<0.05)；按Flynn评价标准治疗组优良率80%,对照组优良率65%,有显著性差异(P<0.05)。治疗组在骨折愈合时间、术后随访影像学资料、肘内翻发生率方面均优于对照组。结论：①小儿肱骨远端全骺分离的治疗,对于无血管损伤的闭合性骨折患者,无手术适应症者均优先考虑手法复位经皮克氏针内固定治疗；有手术适应症者应及时切开复位内固定。②手法复位经皮克氏针内固定治疗肱骨远端全骺分离,其促进骨折愈合、关节功能康复均优于切开复位内固定,肘内翻发生率也低于切开复位内固定。③整体评价手法复位经皮克氏针内固定治疗肱骨远端全骺分离,其优良率高于切开复位内固定,能获得较好的关节康复,降低肘内翻发生率,而且微创、经济,值得临床上推广应用。更多还原

【Abstract】 ObjectiveThis research is about distal humeral epiphysis separation treatment research progress, and evaluation technique closed reduction, kwire fixation in treating pediatric distal humeral epiphysis all the clinical curative effect of separation, analyzes the factors affect curative effect, for distal humeral epiphysis separation treatment options provide clinical evidence.Methods40cases were analyzed retrospectively with into standard distal humerus all cases Hou separation, divided into gimmick closed reduction, kwire fixation (treatment group) open reduction and internal fixation (control group) every20cases, access to medical records and postoperative follow-up, the two groups were observed the fracture healing time, analysis the clinical after one year imaging data (Baumann Angle, support the Angle), observation records of the complications such as cubitus varus, fracture of elbow don’t heal, nerve vascular injury during the treatment period, fixation back loose needles, mouth of infection, the statistical analysis. The Mayo elbow score, Flynn evaluation standard of postoperative function of elbow joint and turned to evaluate the situation.ResultsTwo groups of patients with all the Mayo elbow score, the treatment group was85%, and the control group was75%, the significant difference (P<0.05); According to the Flynn evaluation standard treatment group was80%, and the control group was65%, the significant difference (P<0.05). The treatment group in the healing time, follow-up of imaging material, elbow turn inward, are better than the control group incidence.Conelusion (1) distal humerus all children Hou separation treatment, for no of vascular injury patients with fracture of the closed, no operation indications are the preferred methods by Gerard pique’s reset needle internal fixation for; With operation indications should be timely open reduction and internal fixation.(2) the technique by Gerard pique’s reset needle internal fixation for distal humerus all the Hou separation, promote the fracture healing, joint function recovery is better than open reduction and internal fixation, cubits rate lower than in turn open reduction and internal fixation.(3) the overall evaluation technique by Gerard pique’s reset needle internal fixation for distal humerus all the Hou separation, was higher than the open reduction and internal fixation, can achieve good joint rehabilitation, reduce the incidence of elbow turn, and minimally invasive, economic, and clinical application.更多还原