儿童肱骨髁上骨折术后关节功能恢复临床评估

The clinical analysis of postoperative joint functional recovery about humeral supracondylar fractures in children

[目的]回顾性分析儿童肱骨髁上骨折术后关节活动度(range of motion,ROM)的恢复过程及相关影响因素。[方法]2007年11月～2010年3月间收集71例儿童肱骨髁上骨折的手术病例,同时收集67例儿童前臂远端骨折采用闭合复位、长臂石膏外固定的患者作为对照组,均在1个月后拆除固定装置并进行患肢功能锻炼,系列观察随访至活动度恢复到健侧的90%为止。对儿童肱骨髁上骨折术后及前臂远端骨折外固定后肘关节活动度的恢复情况对比分析。[结果]术前评价两组患者一般资料差异无统计学意义,具有可比性。肱骨髁上骨折组分别需14.05,16.23,3.05,2.11周可恢复肘关节伸、屈及前臂旋前、旋后四个方向的90%活动度。前臂远端骨折组中,肘关节伸、屈及前臂旋前、旋后活动度要恢复到预期目标分别需2周和4～5周。两组患者在肘关节伸屈、前臂旋转功能恢复方面差异有统计学意义。[结论]伸直型儿童肱骨髁上骨折术后固定1个月,肘关节伸屈功能恢复至正常需3～4个月,前臂旋转功能恢复需2～3周,旋后较旋前功能更易于恢复,肘关节屈曲功能恢复最慢。长臂石膏外固定一个月对儿童肘关节功能恢复影响较小。

[ Objective ] To retrospectively investigate the time required for elbow range of motion （ROM） recovery after humeral supracondylar fractures in children and to analyze the related factors. [ Method] Seventy-one children with humerus supracondylar fractures were followed from November 2007 to March 2010. They were treated with open reduction by lateral approach and stabilization by two crossing pins and long arm casts. In the same period,67 children with distal forearm fractures were trea- ted by closed reduction and immobilization with long arm casts. They were used as a control group（without elbow fracture） to study elbow fixation-extension recovery after immobilization. Immobilization devices were removed by one month for all patients. Serial follow-up visit was in progress untill ROM recovering to 90% level of uninjured side in extension ,flexion, pronation, and supination directions. Recovery time was recorded respectively. The information of recovery was analyzed contrastively about mo- tion of elbow in two groups of humerus supracondylar fractures and distal forearm fractures after removing fixation. [ Result] The difference between the 2 groups were not significant in preoperative evaluation and comparability existed. The supracondylar frac- ture group needed 14.05,16.23,3.05, and 2.11 weeks, respectively, in extension, flexion, pronation, supination directions to reach 90% ROM of uninjured side. The distal forearm fracture group only required 2 weeks,4 -5 weeks in forearm pronation- supination directions to recover goal. The functional recovery of elbow flexion-extension and forearm rotation had significant difference between two groups. [ Conclusion] Postoperative immobilization about one month for humerus supracondylar fractures in children, elbow recover to normal function needs 3 - 4 months in flexion-extension directions. The recovery of forearm rotation function require 2 ~ 3 weeks. The supination range is easier to recover than pronation motion. It costs longest time for functional restoration of elbow flexion. Immobilization with long arm cast for one month has little effect on the recovery of elbow function in children.