三种方法治疗儿童肱骨髁上骨折的疗效

Comparison of three treatment methods for humeral supracondylar fracture in children

目的探讨3种治疗方法治疗儿童肱骨髁上骨折的疗效。方法自2007年1月至2009年1月共治疗肱骨髁上骨折79例。按Gartland分类进行分型，应用闭合复位石膏固定、闭合复位经皮交叉克氏针固定、切开复位交叉克氏针内固定治疗。参照Flynn疗效评价标准评价优良率，对结果进行四格表资料的x。检验。结果本组79例全部得到随访，随访时间6—23个月，平均8．8个月。闭合复位石膏固定组24例，优13例，良7例，优良率83．4％；闭合复位经皮交叉克氏针固定组21例，优11例，良6例，优良率81．O％；切开复位交叉克氏针内固定组34例，优10例，良10例，优良率58．8％。Gartland分类I型13例，优10例，良1例，优良率84．6％；II型38例，优18例，良14例，优良率84．2％；III型28例，优6例，良8例，优良率50．0％。治疗组间比较：闭合复位石膏固定组与切开复位交叉克氏针内固定组之间比较差异有统计学意义（χ2＝3．95〉3．84，P〈0．05）；Gartland分类组间比较：I型组与III型组之间（χ2=4．47〉3．84，P〈0．05）、II型组与III型组之间比较（X。：8．93〉3．84，P〈0．05），差异有统计学意义。结论儿童肱骨髁上骨折治疗优良率与治疗方法有密切关系，而治疗方法应该根据患儿骨折的分型做出相应的选择。

Objective To evaluate the therapeutic effect of three treatment methods for humeral supracondylar fracture in children. Methods Seventy nine cases of humeral supracondylar fracture were divided into type I , II and III according to Gartland type and were treated by closed reduction, closed reduction cross percutaneous pinning and open reduction internal fixation separately from Jan. 2007 to Jan. 2009. The outcome were measured according to Flynn criteria that include functional and cosmetic factors which were based on loss of elbow motion and carrying angle in degrees respectively. The results were analyzed with X2 test. Results Seventy nine cases were followed up for 6 -23 months, mean time was 8.8 months. The group of closed reduction had 24 cases, and had excellent results in 13 cases, good in 7 cases, and the excellent - good rate was 83.4%. The group of closed reduction and cross perceuta- neous pinning had 21 cases, and gave excellent results in 11 cases, good in 6 cases, and the excellent- good rate was 81.0%. The group of open reduction internal fixation had 34 cases, and showed excellent in 10 cases, good in 10 cases, and the excellent - good rate was 58.8%. There were no significant difference in the therapeutic effect between closed reduction and closed reduction cross percutaneous pinning, and closed reduction cross percutaneous pinning and open reduction internal fixation; the effect of closed reduction superior to open reduction internal fixation （P 〈 0.05 ）. There was no statistical difference in the therapeutic effect between type I and II fracture; the effect of type II was superior to type 111 （P 〈 0.05 ）, and type I superior to type III 〈 P 〈 0.05）. Conclusions The therapeutic effect of humeral supracondylar fracture in children is closely correlated with the choice of therapy based on the type of fracture and complications.