儿童肱骨髁上骨折治疗中预防肘内翻的探讨

Treatment of supracondylar fracture of humerus in children:How to reduce the incidence of cubitus varus

目的：探讨儿童肱骨髁上骨折治疗中降低肘内翻的发生率。方法：回顾性总结76例肱骨髁上骨折病例资料，按治疗方法分为手法复位加小夹板固定组（A组）31例，手法复位加石膏外固定组（B组）24例，尺骨鹰嘴牵引组（C组，2周后去除牵引改石膏固定）9例，手术治疗组（D组）12例。对A组与B组以及4组中的Ⅲa型骨折病例的疗效进行分析比较，并作统计学处理，着重对肘内翻的预防加以探讨。结果：所有病例经4-36个月随访，通过摄患侧肘关节标准正侧位X线片，治疗前后测量鲍曼氏角（BA角）、携带角（CA角），参照郭仲华等对肱骨髁上骨折疗效标准的评定。A组与B组的疗效比较（χ^2=0．132，P=0．716〉0．05），无显著性差异；C、D组与A、B组中的Ⅲa型骨折治疗结果比较（χ^2=6．078，P=0．014〈0．05），有显著性差异。结论：对于肘内翻的预防应贯穿于骨折复位、固定、复查的全过程。根据骨折类型合理选择治疗方法，正确的复位方法，合理的复位判断及固定方式，手术入路的合理选择无论对保证肘关节的功能还是降低肘内翻的发生率均是关键。

Objective： To discuss effective therapy for supracondylar fracture of humerus in children and how to reduce the incidence of cubitus varus. Methods： 76 patients of supracondylar fractures of humerus in children were collected and their therapeutic effect were analyzed. They were respectively treated with nonoperative therapy（64 cases） and operative therapy（ 12 cases, group D）. in nonoperative therapy group： 31 cases were treated with manipulative reduction and splinting（group A）, 24 cases with manipulative reduction and fixation of the plaster（group B）, 9 cases with traction of olecranon of ulnar （group C, fixation with plaster after relieving traction）. The therapeutic effect were compared between group A and group B. The results of type m a fractures between group C,D and group A,B were analyzed. Results：All the patients were followed up from 4 to 36 months. The clinical effects were evaluated according to BA, CA angle of measurement in the X-ray and standard of clinical effects. There was no statistical difference between group A and group B（ χ^2 = 0. 132, P=0.716 〉0.05）. There was statistical difference for the treatment of type m a fractures between group C, D and group A, B（ χ^2= 6.078, P = 0. 014 〈 0.05）. Conclusion： Preventing the incidence of cubitus varus must penetrate all the course of the treatment. Correct reduction, reasonable fixation and operative approach is a key to ensure function of elbow joint and decrease incidence of cubitus varus.