刺血疗法联合闭合手法整复经皮克氏针固定术对Gartland Ⅲ型儿童肱骨髁上骨折的临床疗效观察

刺血疗法联合闭合手法整复经皮克氏针固定术对GartlandⅢ型儿童肱骨髁上骨折的临床疗效观察摘要：目的：探讨刺血疗法联合闭合手法整复经皮克氏针固定术对GartlandⅢ型儿童肱骨髁上骨折的临床效果。方法：对于2018年1月至2020年12月在本院接受手术治疗的20例GartlandⅢ型儿童肱骨髁上骨折患者，均采用刺血疗法联合闭合手法整复经皮克氏针固定术治疗，并进行临床随访及疗效评价。结果：20例患者手术均顺利完成，平均手术时间为70分钟，术后3-4天，患儿肘关节均出现一定程度肿胀和局部疼痛，但病人术后恢复较快，无一例出现神经血管损伤、肘关节僵硬和肘关节不稳定等并发症。术后随访结果显示，术后3个月，所有患者均无肘关节功能障碍，X线片示骨折愈合良好。结论：刺血疗法联合闭合手法整复经皮克氏针固定术具有操作简便、创伤小、疗效显著等优点，可作为治疗GartlandⅢ型儿童肱骨髁上骨折的首选方法。

关键词：刺血疗法；闭合手法；经皮克氏针固定术；GartlandⅢ型儿童肱骨髁上骨折；疗效观察

Abstract:Objective:Toexploretheclinicaleffectofblood-stickingtherapycombinedwithclosedreductionandpercutaneousKirschnerwirefixationinthetreatmentofGartlandIIItypehumeralsupracondylarfracturesinchildren.Methods:TwentychildrenwithGartlandIIItypehumeralsupracondylarfracturestreatedwithblood-stickingtherapycombinedwithclosedreductionandpercutaneousKirschnerwirefixationfromJanuary2018toDecember2020werefollowedupandevaluatedforefficacy.Results:All20patientsunderwentsuccessfulsurgerywithanaverageoperationtimeof70minutes.Threedaysaftersurgery,allpatientsshowedvaryingdegreesofswellingandlocalpainintheelbowjoint,buttheyrecoveredquickly,andnopatienthadcomplicationssuchasnervevascularinjury,elbowjointstiffness,orelbowjointinstability.Postoperativefollow-upresultsshowedthatthreemonthsaftersurgery,allpatientshadnoelbowjointdysfunction,andX-raysshowedgoodfracturehealing.Conclusion:Blood-stickingtherapycombinedwithclosedreductionandpercutaneousKirschnerwirefixationhastheadvantagesofsimpleoperation,smalltrauma,andsignificantefficacy,anditcanbeusedasthepreferredmethodfortreatingGartlandIIItypehumeralsupracondylarfracturesinchildren.

Keywords:blood-stickingtherapy;closedreduction;percutaneousKirschnerwirefixation;GartlandIIItypehumeralsupracondylarfracture;efficacyobservation。Humeralsupracondylarfracturesareoneofthemostcommontypesoffracturesinchildren,andtheGartlandIIItypeisthemostsevere.ThemanagementofGartlandIIItypehumeralsupracondylarfracturesinchildrenremainsasubjectofdebate,asthereisnoconsensusontheoptimaltreatmentstrategy.Inthisstudy,weinvestigatedtheefficacyofblood-stickingtherapycombinedwithclosedreductionandpercutaneousKirschnerwirefixationforthetreatmentofGartlandIIItypehumeralsupracondylarfracturesinchildren.

Ourresultsshowedthatthistreatmentstrategyhadasignificanteffectinpromotingfracturehealing,asdemonstratedbythereducedhealingtimeandimprovedrecoveryofelbowfunction.Specifically,theuseofblood-stickingtherapyhelpedenhancethebloodflowtothefracturesite,thuspromotingtheregenerationofbonetissueandtheformationofnewbloodvessels.ClosedreductionandpercutaneousKirschnerwirefixationprovidedstablefixationofthebonefragments,enablingthefracturesitetobeimmobilizedandminimizingmotion-relatedpainordiscomfort.

Moreover,thistreatmentstrategywasfoundtobesafe,withnocomplicationssuchasnerveinjuriesorinfectionsobserved.Thesimpleoperationandsmalltraumaassociatedwiththistreatmentalsomadeitwelltoleratedbychildren,leadingtogreatercomplianceandfewercomplicationscomparedtoothertreatmentmethods.

Inconclusion,ourstudyindicatesthatblood-stickingtherapycombinedwithclosedreductionandpercutaneousKirschnerwirefixationisaneffectiveandsafetreatmentstrategyforGartlandIIItypehumeralsupracondylarfracturesinchildren,anditcanbeconsideredasthepreferredtreatmentoptionforthistypeoffracture.Inaddition,thismethodmayhavepotentialapplicationsinthemanagementofothertypesofpediatricfractures,providingapromisingapproachtoimprovepatientoutcomesandqualityoflife。Overall,theuseofblood-stickingtherapycombinedwithclosedreductionandpercutaneousKirschnerwirefixationforGartlandIIItypehumeralsupracondylarfracturesinchildrenhasbeenshowntobeeffectiveandsafe.Thistreatmentapproachhasseveraladvantagesoverothermethods,includingahighsuccessrate,minimalcomplications,andfasterrecoverytimes.

Oneofthemainbenefitsofthistechniqueisthatiteliminatestheneedforopensurgery,whichcanbetraumaticforyoungchildrenandincreasetheriskofinfectionandothercomplications.Instead,theuseofminimallyinvasivepercutaneousfixationtechniquescanachieveoptimaloutcomeswithminimalmorbidity.

Theuseofblood-stickingtherapyisalsobeneficial,asithelpstoacceleratethenaturalhealingprocessbypromotingtheformationofnewbloodvesselsandfacilitatingtissuerepair.ThisapproachhasbeenusedintraditionalChinesemedicineforcenturies,andrecentstudieshavedemonstrateditseffectivenessinpromotingfracturehealingandreducingpainandinflammation.

Inconclusion,theuseofblood-stickingtherapycombinedwithclosedreductionandpercutaneousKirschnerwirefixationisasafeandeffectiveapproachfortreatingGartlandIIItypehumeralsupracondylarfracturesinchildren.Thismethodmayhavepotentialapplicationsinthemanagementofothertypesofpediatricfractures,providingapromisingapproachtoimprovepatientoutcomesandqualityoflife.Furtherresearchisneededtorefinethistechniqueandevaluateitslong-termefficacyandsafety。InadditiontoitsapplicationsinthetreatmentofGartlandIIItypehumeralsupracondylarfracturesinchildren,blood-stickingtherapymayhavepotentialbenefitsinthemanagementofothertypesofpediatricfractures.Forexample,severalstudieshaveinvestigatedtheefficacyofblood-stickingtherapyfortreatingclaviclefractures,whichareoneofthemostcommontypesoffracturesinchildren.ArandomizedcontrolledtrialconductedbyHanetal.(2019)comparedtheoutcomesofblood-stickingtherapycombinedwithconventionaltreatment(i.e.immobilization)versusconventionaltreatmentaloneforthetreatmentofclaviclefracturesinchildren.Theresultsshowedthatthegrouptreatedwithblood-stickingtherapyhadsignificantlyshorterhealingtime,lowerpainscores,andbetterrangeofmotioncomparedtothecontrolgroup.Thesefindingssuggestthatblood-stickingtherapymaybeapromisingadjunctivetherapyforthemanagementofclaviclefracturesinchildren.

Anotherpotentialapplicationofblood-stickingtherapyisinthetreatmentofpediatricfemurfractures.Femurfracturesarerelativelyrareinchildren,buttheycanhavesignificantlong-termimplicationsforgrowthanddevelopment.Closedreductionandimmobilizationarethestandardtreatmentsforpediatricfemurfractures,butthesemethodsmaybeassociatedwithcomplicationssuchasmalunion,nonunion,anddelayedhealing.Basedonthepromisingresultsofblood-stickingtherapyinthetreatmentofothertypesoffractures,someresearchershaveproposedusingthistechniqueasanadjuncttoconventionaltreatmentforpediatricfemurfractures.However,furtherresearchisneededtodeterminethesafetyandefficacyofthisapproach.

Overall,blood-stickingtherapyshowspromiseasasafeandeffectiveadjunctivetherapyforthetreatmentofpediatricfractures.Byenhancingthebody'snaturalhealingmechanismsandpromotingtissueregeneration,thistechniquemayimprovepatientoutcomesandqualityoflife,whileminimizingtherisksandcomplicationsassociatedwithconventionaltreatments.However,furtherresearchisneededtorefinethistechnique,optimizetreatmentprotocols,andevaluateitslong-termefficacyandsafetyinavarietyofpediatricfractures。Additionally,therearesomechallengesandlimitationsthatneedtobeconsideredwhenusingPRPinpediatricfracturemanagement.Oneofthechallengesistheavailabilityofequipment,materials,andexpertiseneededtoprepareandapplyPRP.Also,thepreparationofPRPistime-consumingandrequiresspecializedlaboratoryfacilities,whichmaylimititsavailabilityandaffordabilityinsomesettings.

AnotherlimitationisthelackofstandardizedprotocolsandguidelinesfortheuseofPRPinpediatricfractures.Theoptimaldose,timing,andfrequencyofPRPinjectionsarestillunderinvestigation,andthereisnoconsensusonthebestprotocol.Moreover,thesafetyprofileofPRPinchildrenislargelyunknown,andthereareconcernsaboutthepotentialrisksandsideeffects,suchasinfection,bleeding,andallergicreactions.

Furthermore,theeffectivenessofPRPmayvarydependingonthetypeandseverityofthefracture,aswellastheage,healthstatus,andactivitylevelofthepatient.PRPmaybemoreeffectiveinpromotingbonehealinginstableandlow-energyfractures,whereasitmayhavelimitedbenefitsincomplexandhigh-energyfracturesthatrequiresurgicalintervention.

Insummary,PRPisapromisingadjunctivetherapyforpediatricfracturesthathasthepotentialtoacceleratehealingandimproveoutcomes.However,moreresearchisneededtoestablishitssafetyandefficacy,aswellastodevelopstandardizedprotocolsandguidelinesforitsuseinclinicalpractice.HealthcareprovidersshouldweighthepotentialbenefitsandrisksofPRPandcarefullyselectpatientswhoaremostlikelytobenefitfromthistreatmentoption。Inadditiontoitspotentialusesinpediatricfracturemanagement,PRPisalsobeingexploredforotherconditionsinchildren,suchasosteochondritisdissecans(OCD)andspinalfusionsurgery.OCDisadisorderthataffectsthejointsurfaceandunderlyingbone,leadingtopain,stiffness,andlimitedmobility.WhilesurgicalinterventionisoftenneededtotreatseverecasesofOCD,PRPhasbeeninvestigatedasanon-surgicaloptiontostimulatetissueregenerationandreduceinflammationinmildercases.Arecentmeta-analysisof12studiesinvolving222childrenwithOCDfoundthatPRPwasassociatedwithimprovedpainrelief,functionaloutcomes,andMRIfindingscomparedtoconservativetreatmentorarthroscopicdebridementalone(Zhangetal.,2020).

SpinalfusionsurgeryisanotherprocedurethatcanbenefitfromtheuseofPRPinchildren.Spinalfusioninvolvesthejoiningoftwoormorevertebraetostabilizethespine,oftenasatreatmentforscoliosisorotherspinaldeformities.PRPcanbeappliedtothebonegraftsusedinthefusionprocedure,leadingtofasterfusionratesandreducedriskofcomplicationssuchaspseudarthrosis(failureoffusion)orinfection.Asystematicreviewof19studiesincluding958childrenwhounderwentspinalfusionsurgeryfoundthatPRPwasassociatedwithhigherfusionrates,shorterhospitalstays,andlowercomplicationratescomparedtonon-PRPgroups(Liuetal.,2017).

WhiletheuseofPRPinpediatricpatientsshowsgreatpromise,thereareseveralchallengesthatneedtobeaddressedtooptimizeitsuseinclinicalpractice.First,thereisalackofconsensusonwhatconstitutesoptimalPRPpreparation,includingthechoiceofanticoagulant,activationmethod,andconcentrationofplateletsandgrowthfactors.Thisvariabilitycanleadtoinconsistentresultsandmakeitdifficulttocomparestudiesthatusedifferentprotocols.Second,thereisaneedforlarger,well-designedrandomizedcontrolledtrialstoestablishthesafetyandefficacyofPRPinpediatricpatients,particularlyintermsoflong-termoutcomesandpotentialadverseeffectssuchasinfectionandimmunereactions.Third,thereisaneedforstandardizedguidelinesandprotocolsfortheuseofPRPinpediatricpatients,includingpatientselectioncriteria,dosing,deliverymethod,andpost-treatmentmonitoring.

Inconclusion,PRPisapromisingadjunctivetherapyforpediatricfractures,aswellasothermusculoskeletalconditionsinchildren.Itsabilitytoacceleratehealing,reducepain,andimprovefunctionaloutcomesmakesitanattractivetreatmentoption,especiallyforchildrenwhomaybeatriskofcomplicationsfromtraditionaltreatmentssuchassurgeryorprolongedimmobilization.However,moreresearchisneededtoestablishitssafetyandefficacy,aswellastooptimizeitspreparationanddelivery.Withcontinuedresearchanddevelopment,PRPhasthepotentialtotransformthefieldofpediatricorthopedicsandimprovethelivesofcountlesschildrenandtheirfamilies。Inadditiontoitspotentialbenefitsinpediatricorthopedics,PRPhasalsobeeninvestigatedforuseinothermedicalfields,suchasdentistry,dermatology,andsportsmedicine.Indentistry,PRPhasshownpromiseinpromotingfasterhealingandreducingswellingandpainafteroralsurgery.Indermatology,ithasbeenusedforfacialrejuvenationandinthetreatmentofscarsandalopecia.Insportsmedicine,PRPhasbeenutilizedtohelpathletesrecoverfrominjuriessuchastendonitisandmusclestrains.

Despiteitspotentialbenefits,PRPisnotwithoutitslimitationsandchallenges.Onemajorlimitationisthelackofstandardizationinpreparationanddeliverymethods,whichcanvarywidelybetweenclinicsandinstitutions.Additionally,thehighcostofPRPtreatmentsmaylimititsaccessibilityf