有限切开复位与闭合复位治疗儿童GartlandⅢ型肱骨髁上骨折的疗效比较

Limited open reduction versus closed reduction in treatment of supracondylar humerus fractures in children

目的比较有限切开复位与闭合复位内固定治疗儿童GartlandⅢ型肱骨髁上骨折的疗效。方法回顾性分析2008午1月至2010年12月收治并扶随访的98例JLNGartland11I型肱骨髁上骨折患者资料，其中有限切开复位组（行内侧或外侧小切口切开复位内固定）78例，男53例，女25例；平均年龄为75．9个月。闭合复位组（行闭合复位内固定）20例，男15例，女5例；平均年龄为70．7个月。比较两组患者的手术时间、术中透视次数和骨折愈合时间。术后3个月和1年时采用Flynn肘关节坪分标准评定疗效。结果有限切开复值组手术时间［（52．2±7．0）mm］较闭合复位组［（72．8±13．7）min］短；术中透视次数［（3．3±1．0）次］少于闭合复位组]（9．9±1．9）次]，差异均有统计学意义（P〈0．05）。所有患者术后获12～24个月（平均16．3个月）随访，均在术后4周获骨折临床愈合，术后2个月获骨性愈合。按照Flynn肘关节评分标准评定疗效：术后3个月有限切开复值组优良率［24．4（19/78）］与闭合复位组［30％（6／20）]比较，差异无统计学意义（P〉0．05）；术后1年有限切开复位组优良率［100％（78／78）］与闭合复位组［95％（19／20）］，比较差异有统计学意义（P〈0．05）。两组均无骨折延迟愈合、骨筋膜间室综合征和医源性血管冲经损伤等并发症发生，无一例需再次行髁上截骨术。结论有限切开复位与闭合复位治疗儿童GartlandⅢ肱骨髁上骨折，骨折愈合时间相同，而无法闭合复位的儿童GartlandⅢ型肱骨髁上骨折可通过有限切开复位获得满意复位，且后者手术时间短、术中透视次数少、术后1年患者肘关节功能更好。

Objective To compare the clinical effects of limited open reduction versus closed reduction in treatment of supracondylar humenrus fractres （GartlandⅢ） in children. Methods The clinical data of 98 children who had been treat for supracondylar humerus fractures （GartlandⅢ ） inour department from January 2008 to December 2010 were available for the present retrosptive analysis.Eighty-seven patients were treated with open reduction via a limited medial or lateral incision followed hy internal fixation while the other 20 with closed reduction followed by internal fixation. In the limited open reduetion group, there were 53 boys and 25 girls, with a mean age of 76.4 months; in the closed reduction group, there were 15 boys and 5 girls, with a mean age of70. 7 months. The 2 goups were compared in terms of operative time,intraoperative radiography frequency, fracture healing, Flynn elbow scoring at 3 and 12 months postoperation. Results Compared with the closed reduction group, the limited open reduction group needed significantly shorter average operative time （52. 2 ± 7.0 minutes versus 72, 8± 13, 7 minutes） and significantly lower average intraoperative radiography frequency （3.3 ±1.0 times venus 9. 9 ± 1.9times） （ P 〈 0.05）. The 98 patients received a mean follow-up of 16. 3 months （from 12 to 24 months）. All the fractures achieved clinical healing at 4 weeks post-operation and bony union at 2 months post-operation. By the Flynn elbow scoring at 3 months postoperation, the good to excellent rate was 24.4 % （19/78） in the limited open reduction group and 30.0% （6/20） in the closed reduction group, with no signiificant difference （ P 〉 0.05） . However, the good to excellent rate at 12 months post-operation was 100% （78/78） in the limited open reduction group and 30.0% （6/20） in the closed reduction group, with no significant difference （ P 〉 0.05） . However, the good to excellent rate at 12 months post-operation was 100% （78/78） in the limited open reduction group and 95.0% （19/20） in the closed reduction group, with a significant difference （P 〈 0.05）. No delayed union, compartment syndrome or iatrogenic lesions to vessels and nerves occurred and no supracondylar osteotomy was needed in either group.Conclusions In treatment of supracondylar humerus fractures （Gartland type Ⅲ） in children, both limited open reduction and closed reduction can lead to fracture healing in similar time and similar functional recovery of the elbow. It is essential to perform limited open reduction when closed reduction fails. Limited open reduction can result in shorter operative time, lower intraoperative radiography frequency and better functional outcomes.