小夹板配合动力型肘关节支具预防肘内翻的临床研究

Clinical Study on Splint Fixation Combined with Orthopedic Elastic Elbow Brace in Preventing Cubitus Varus in Children with Humeral Supracondylar Fracture

【目的】研究小夹板配合动力型肘关节支具对预防儿童肱骨髁上骨折并发肘内翻发生的疗效。【方法】将100例肱骨髁上骨折患儿随机分为治疗组52例及对照组48例,均采用中医正骨手法整复,小夹板四夹超肘外固定。治疗组配合使用佛山市中医院小儿骨科研制的动力型肘关节支具,观察其Baumann角度变化,以及进行近期和远期肘关节功能评价。【结果】(1)经1年以上随访,所有病例均达到骨折治愈标准;治疗组发生肘内翻为0例,对照组为3例。(2)患侧与健侧B角角度差随时间的推移有逐渐增大的趋势,复位30 d开始至90 d与复位后比较,其角度差的差异均有统计学意义(P<0.05或P<0.01),且对照组的角度差增加的幅度较治疗组更显著(P<0.05或P<0.01)。复位90 d～1年,其角度差变化不大,表明复位90 d后已进入稳定期。(3)治疗组近期和远期肘关节功能评价结果均优于对照组(P<0.01)。【结论】配合使用动力型肘关节支具对肱骨髁上骨折中后期功能恢复和减少并发肘内翻的发生效果明显,是传统小夹板的有效补充。

Objective To observe the therapeutic effect of splint fixation combined with orthopedic elastic elbow brace for preventing humeral supracondylar fracture complicated with cubitus varus in children. Methods One hundred children with the closed humeral supraeondylar fracture were divided into treatment group （N=52） and control group （N=48） . All of the children were given the same treatment of manipulative reduction and external fixation with four splints around the affected elbow. Additionally, the treatment group was also given the dynamic elbow brace which has been developed by our department. The changes of Baumann angle were monitored, and the short-term and long-term effect on elbow function was also evaluated. Results The results of follow-up over one year showed that all of the patients were cured according to the criteria of fracture healing, cubitus varus did not occur in the treatment group, but occurred in 3 cases of the control group. The differenceof Baumann angle of the affected elbow and the healthy elbow tended to increase with time, the angle difference from day 30 to 90 after the reduction differed from that the time of finishing reduction （P〈0.05 or P〈0.01 ） . The increase of the angle difference in the control group was superior to that in the treatment group （P〈0.05 or P〈 0.01） . The angle difference in both groups became steady from day 90 to year one after the reduction, indicating that the steady phase was from day 90. Treatment group had better short-term and long-term effect than the control group （P〈 0.01） . Conclusion The application of orthopedic elastic elbow brace during the splint fixation is effective on the elbow function recovery and on the reduction of cubitus varus incidence at the middle- and late-stage of humeral supracondylar fracture in children.