肘内侧入路手术切开复位对儿童难治性肱骨髁上骨折的疗效

Efficacy of Open Reduction Through Medial Exposure Therapy for Children with Intractable Humeral Supracondylar Fracture

目的探讨肘内侧入路手术切开复位治疗难治性肱骨髁上骨折(GartlandⅢ型)的效果。方法2005年9月-2008年8月本院收治240例GartlandⅢ型肱骨髁上骨折,入院2 d后复查X线片,按照其X线移位改善情况进行分组。其中142例全麻下采用肘内侧入路手术切开复位后克氏针交叉固定加石膏外固定治疗(手术组),98例进行传统的水平外展位皮肤牵引治疗(保守组),均于治疗4周后拆除石膏开始功能锻炼,定期摄X线片观察临床疗效。并对患儿进行长期随访观察,随访时间6个月～3 a。疗效评价采用Flynn临床功能评定标准,并对肘关节屈伸功能和提携角改变至肘内翻进行分组统计学检验。结果肘关节功能评定手术组130例优良(84.7%),12例中、差;保守组83例优良(91.5%),15例中、差,二组优良率比较无显著差异(P>0.05)。随访中,肘内翻畸形手术组发生2例,保守组发生8例,二组比较有显著性差异(P<0.05)。结论肘内侧入路手术切开复位治疗Gart-landⅢ型肱骨髁上骨折,临床疗效满意,住院时间短,为一种临床优良的治疗方法。

Objective To explore the clinical efficacy of open reduction through medial therapy on intractable humeral supracondylar fracture （ Gartland type Ⅲ ）. Methods Gartland type Ⅲ humeral supracondylar fracture 240 cases, from Sep. 2005 to Aug. 2008 in our department, were divided into 2 groups by the X - ray photography, 142 cases received open reduction through medial exposure plus crossed Kirsehner wire internal fixation and plaster external fixation （operation group） ,while 98 cases received traditional skin traction （non -operation group） ,removal of gypsum and rehabilitation after 4 weeks. X -ray photography was regularly used to observe the clinical curative effect. All cases were followed up for a long - time, for 6 months -3 years. According to Flynn criteria, statistical tests of the elbow function and eubitus varus were measured. Results One hundred and thirty cases were good and 12 cases were below the mark in operation group,83 cases were good and 15 cases were below the mark in non - operation group, there was no significant difference between the 2 groups （ P 〉 0.05 ）. The eubitus varus incidence evaluation was done by follow - up study ,2 cases were in operation group and 8 cases in non - operation group, there was a significant difference between the 2 groups （ P 〈 0.05 ）. Conclusions Open reduction through medial exposure could be firmly fixed, with a benefit of shorter stay at hospital,which is a clinical satisfied treatment for Gartland type Ⅲ humeral supracundylar fracture in children.