【摘要】 目的 探讨撬拨复位后不同内固定方式对桡骨颈骨折患儿创伤应激、关节功能及术后并发症发生率的影响。方法 选择河南省洛阳正骨医院2021年6月至2023年6月65例桡骨颈骨折患儿为研究对象。将患儿随机分为克氏针组(n=32)与髓内钉组(n=33)。两组均采用肘关节造影下撬拨复位，之后克氏针组置入克氏针内固定，髓内钉组置入弹性髓内钉内固定。比较两组围术期基本指标、创伤应激[术前、术后24 h和72 h的促肾上腺皮质激素(ACTH)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、皮质醇(Cor)]、复位质量、术后6个月患侧与健侧肘关节活动度(屈、伸、旋前、旋后)、功能预后及并发症情况。结果 髓内钉组手术时间长于克氏针组，住院费用高于克氏针组(P<0.05)。髓内钉组术后24 h和72 h的ACTH、IL-6、TNF-α、Cor与克氏针组比较，差异未见统计学意义(P >0.05)。髓内钉组复位质量与克氏针组比较，差异未见统计学意义(P > 0.05)。髓内钉组术后6个月患侧肘关节屈、伸、旋前、旋后与克氏针组比较，差异未见统计学意义(P > 0.05)。两组功能预后比较，差异未见统计学意义(P >0.05)。髓内钉组并发症发生率与克氏针组比较，差异未见统计学意义(P > 0.05)。结论 撬拨复位后克氏针与弹性髓内钉内固定均能取得满意的疗效，但克氏针内固定治疗桡骨颈骨折手术时间短、成本低。更多还原

【Abstract】 Objective To investigate the effects of different internal fixation methods on traumatic stress,joint function and postoperative complications in children with radial neck fracture after prying reduction. Methods A total of 65 children with radial neck fracture in Luoyang Orthopaedic Hospital of Henan Province from June 2021 to June 2023 were enrolled and randomly divided into the Kirschner pin group( n = 32) and the intramedullary nail group( n = 33). Both groups were treated by prying under elbow arthrography,followed by internal fixation with Kirschner pin in the Kirschner pin group and elastic intramedullary nail in the intramedullary nail group. The basic parameters,traumatic stress [adrenocorticotropic hormone( ACTH),interleukin-6( IL-6),tumor necrosis factor-α( TNF-α),and cortisol( Cor) before surgery,24 hours and 72 hours after surgery],reduction quality,elbow motion( flexion,extension,pronation,supination) on the affected side and healthy side at 6 months after surgery,functional prognosis and complications were compared between the two groups. Results The operation time of the intramedullary nail group was longer than that of the Kirschner needle group,and the hospitalization cost was higher than that of the Kirschner needle group( P < 0. 05). There was no significant difference in ACTH,IL-6,TNF-α and Cor between the intramedullary nail group and the Kirksh needle group at 24 hours and 72 hours after surgery( P > 0. 05). There was no significant difference in the reduction quality between the intramedullary nail group and the Kirschner’s needle group( P >0. 05). At 6 months after the operation,there was no significant difference in flexion,extension,pronation and supination of the affected elbow joint between the intramedullary nail group and the Kirschian needle group( P > 0. 05). There was no significant difference in the functional prognosis between the two groups( P > 0. 05). The incidence of complications in the intramedullary nail group was not significantly different from that in the Kirschner’s needle group( P > 0. 05). Conclusions Both Kirschner needle and elastic intramedullary nail can achieve satisfactory curative effect after pry reduction,but Kirschner needle internal fixation in the treatment of radial neck fracture is short in operation time and low in cost.更多还原