两种克氏针固定方法治疗儿童肱骨髁上骨折疗效比较

Comparison of two approaches for the treatment of supracondylar fractures in children by K-wires

目的:探讨两种克氏针固定方法治疗儿童肱骨髁上骨折的疗效。方法:自2004年1月至2006年12月应用克氏针内固定治疗儿童肱骨髁上骨折117例,按克氏针固定方式分组:两针组45例,男31例,女14例;年龄1～11岁,平均5.6岁;Garland Ⅱ型19例,Ⅲ型26例。三针组72例,男47例,女25例;年龄2～12岁,平均6.8岁;Garland Ⅱ型22例,Ⅲ型50例。术后测量肘关节屈伸范围及提携角,参照Flynn肱骨髁上骨折疗效评定标准及术后并发症情况,分析两种克氏针内固定方式的疗效。结果:所有患儿均获随访,时间2～24个月,平均15.4个月。两针组45例:优27例,良12例,可4例,差2例,41例术后6周均获得骨性愈合,4例术后1周骨折端移位,固定失败,肘内翻畸形2例。三针组72例:优60例,良11例,差1例,所有患儿术后6周均获得骨性愈合,屈伸活动度经功能锻炼后基本恢复正常,肘内翻畸形1例。结论:克氏针固定是一种稳定而可靠的治疗儿童肱骨髁上骨折方法,内外髁三针交叉固定较单纯外髁两针固定有更大的优点。

Objective：To explore the clinical effect between two approaches for the treatment of supracondylar fractures of humerus by K-wires in children. Methods：From Jan. 2004 to Dec. 2006,117 children with supracondylar fractures of humerus were divided into two groups according to different methods of the K-wires fixation involving two K-wires group and three K-wires group. In two K-wires groups,there were 45 children including 31 boys and 14 girls with an average age of 5.6 years ranging from 1 to 11 years;according to Garland classification,19 cases were typeⅡ,26 cases were type Ⅲ. In three K-wires groups,there were 72 children including 47 boys and 25 girls with an average age of 6.8 years ranging from 2 to 12 years;according to Garland classification,22 cases were type Ⅱ,50 cases were typeⅢ. The movement and carrying angle of elbow joint were measured for all these patients. According to Flynn criteria for supracondylar fracture the results of two approaches with K-wires were compared. Results：All patients were followed up from 2 to 24 months（means 15.4 months）. In two K-wires group, the results of Flynn were excellent in 27 cases,good in 12 cases,fair in 4 cases and poor in 2 cases,41 cases gained bony healing,however,fail of fixation arosed in 4 cases and cubitus varus arosed in 2 cases. In three K-wires group,the results of Flynn were excellent in 60 cases,good in 11 cases and poor in 1 case,all cases of three K-wires group achieved bony healing after 6 weeks of operation,the function of joints recovered through exercise and cubitus varus arosed in one case after operation. Conclusion：The technique of fixation with K-wires is a stable and reliable methods for unstable supracondylar fracture but mediallateral three pin fixation is better than one with two pins.