發(fā)布時(shí)間：2018-11-10 18:27

【摘要】：目的探討兒童新鮮孟氏骨折的閉合手法復(fù)位石膏外固定、尺骨切開(kāi)復(fù)位鋼板內(nèi)固定以及單枚克氏針固定肱橈關(guān)節(jié)加尺骨切開(kāi)復(fù)位鋼板內(nèi)固定三種治療方法的療效分析,為該疾病的診治提供更好的診療技術(shù)、理論基礎(chǔ)及相關(guān)依據(jù),以提高兒童新鮮孟氏骨折的臨床治愈療效。方法本文通過(guò)收集鄭州大學(xué)第一附屬醫(yī)院骨外科2014年11月至2017年1月收治的48例患兒資料,并對(duì)所有資料進(jìn)行回顧性研究分析,以探討其臨床療效。將這48例新鮮孟氏骨折患兒依據(jù)治療方式分為A、B、C三組,每組各16例,A組患兒采用閉合手法復(fù)位石膏外固定,B組采用尺骨切開(kāi)復(fù)位鋼板內(nèi)固定治療,C組采用單枚克氏針固定肱橈關(guān)節(jié)加尺骨切開(kāi)復(fù)位鋼板內(nèi)固定。術(shù)后隨訪6~24個(gè)月(平均12個(gè)月),通過(guò)對(duì)照三組治療方式患兒年齡性別、分型、骨折愈合時(shí)間,得出結(jié)果;依據(jù)Mayo肘關(guān)節(jié)功能評(píng)分系統(tǒng)得到三組治療方式優(yōu)良率及脫位率;隨訪中測(cè)量患兒患側(cè)肘關(guān)節(jié)屈伸(f/e)、旋轉(zhuǎn)(p/s)范圍度,并測(cè)量對(duì)側(cè)肘關(guān)節(jié)屈伸(f/e)、旋轉(zhuǎn)(p/s)范圍度,將得到的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,得出結(jié)果;根據(jù)肘關(guān)節(jié)功能評(píng)價(jià)法(JOA)計(jì)算肘關(guān)節(jié)功能得分,并進(jìn)行統(tǒng)計(jì)學(xué)分析,得出結(jié)果。應(yīng)用SPSS20.0統(tǒng)計(jì)軟件對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)分析,檢驗(yàn)水準(zhǔn)α=0.05。結(jié)果術(shù)后所有患兒均獲得6~24個(gè)月(平均12個(gè)月)的隨訪,隨訪期間所有患兒無(wú)其他損傷及死亡情況。對(duì)這三個(gè)組的數(shù)據(jù)進(jìn)行回顧性研究分析,三組治療方式在年齡性別、分型、骨折愈合時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。三種治療方式術(shù)后肘關(guān)節(jié)功能評(píng)分優(yōu)良率及脫位率差異有統(tǒng)計(jì)學(xué)意義(P0.05);通過(guò)觀察三組患兒治療后患側(cè)及健側(cè)伸屈范圍度和前臂旋轉(zhuǎn)范圍度,得出A組及B組分別在旋轉(zhuǎn)范圍和屈伸范圍與健側(cè)差異有統(tǒng)計(jì)學(xué)意義;C組屈伸及旋轉(zhuǎn)范圍與健側(cè)差異無(wú)統(tǒng)計(jì)學(xué)意義;根據(jù)活動(dòng)范圍度分別計(jì)算出功能得分,得出三組治療方式肘關(guān)節(jié)功能得分與健側(cè)均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論A、B、C三組治療方式在治療后愈合時(shí)間無(wú)差別,但C組肘關(guān)節(jié)優(yōu)良率高于A、B兩組,而通過(guò)脫位率證明利用克氏針固定肱橈關(guān)節(jié)(C組)可更好預(yù)防術(shù)后橈骨小頭脫位;A、B、C三組治療方式在治療后肘關(guān)節(jié)功能得分與健側(cè)并無(wú)差異,但A組及B組患兒治療后肘關(guān)節(jié)較健側(cè)比較分別有旋轉(zhuǎn)和屈伸功能障礙,C組治療后患兒肘關(guān)節(jié)活動(dòng)度與健側(cè)無(wú)差異,術(shù)后屈伸、旋轉(zhuǎn)功能均愈合佳;綜上所述,單枚克氏針固定肱橈關(guān)節(jié)加尺骨切開(kāi)復(fù)位鋼板內(nèi)固定治療方式在術(shù)后肘關(guān)節(jié)屈伸、前臂旋前旋后及肘關(guān)節(jié)功能方面均療效顯著,優(yōu)良率高且可預(yù)防術(shù)后橈骨小頭脫位,在臨床中可作為治療兒童新鮮孟氏骨折的首選方法。
[Abstract]:Objective to investigate the curative effect of closed manual reduction and plaster external fixation, open reduction and internal fixation of ulnar plate and single Kirschner needle fixation of brachioradial joint and open reduction plate of ulnar bone in children with fresh Monteggia fracture. To provide better diagnosis and treatment technology, theoretical basis and relevant basis for the diagnosis and treatment of the disease, in order to improve the clinical curative effect of fresh Monteggia fracture in children. Methods from November 2014 to January 2017, 48 cases of children in the Department of Bone surgery of the first affiliated Hospital of Zhengzhou University were collected and analyzed retrospectively. According to the treatment, 48 cases of fresh Monteggia fracture were divided into three groups: group A (n = 16) and group B (n = 16). Group A was treated with closed manipulative reduction and plaster external fixation, group B was treated with open reduction of ulna and internal fixation with plate. In group C, single Kirschner needle was used to fix brachioradial joint and ulnar open reduction plate. The patients were followed up for 6 ~ 24 months (mean 12 months), and the results were obtained by comparing the three treatment methods: age, sex, classification, fracture healing time, and the excellent and good rate and dislocation rate of the three groups were obtained according to the Mayo elbow joint function scoring system. The range of elbow flexion and extension (f / r e), rotation (p / s), contralateral elbow flexion and extension (f / e), rotation (p / s) were measured during follow-up. According to the elbow function evaluation method (JOA) to calculate the elbow joint function score, and carries on the statistical analysis, obtains the result. The results were analyzed by SPSS20.0 software, and the test level was 偽 = 0.05. Results all the children were followed up for 6 ~ 24 months (mean 12 months). The data of the three groups were analyzed retrospectively. There was no significant difference between the three groups in age sex type fracture healing time (P0.05). The excellent and good rate of elbow joint function score and dislocation rate were significantly different between the three treatment methods (P0.05). By observing the range of extension and flexion and the degree of rotation of forearm after treatment, the results showed that the range of rotation and flexion and extension of group A and group B were significantly different from those of healthy side. In group C, there was no significant difference between flexion, extension and rotation range and healthy side. According to the range of activities, the functional score of elbow joint in group C was calculated, and no significant difference was found between the functional score of elbow joint and healthy side in three groups (P0.05). Conclusion there is no difference in healing time among the three groups, but the excellent and good rate of elbow joint in group C is higher than that in group A and B. The dislocation rate showed that Kirschner's needle fixation of the brachioradial joint (group C) was a better way to prevent the dislocation of the radial head after operation. There was no significant difference in elbow function between group A and group B after treatment, but there were rotation and flexion and extension dysfunction of elbow after treatment in group A and group B, respectively. In group C, there was no difference between elbow motion and normal side after treatment, and the function of flexion and extension and rotation healed well after operation. To sum up, single Kirschner needle fixation of brachioradial joint and open reduction of ulnar plate is effective in elbow joint flexion and extension, forearm pronation and elbow joint function. The excellent and good rate is high and can prevent the dislocation of the radial head after operation. It can be used as the first choice in the treatment of fresh Monteggia fracture in children.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.8

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