闭合和开放复位克氏针固定治疗儿童肱骨髁上骨折的疗效比较

Efficacy Comparison of Closed Percutaneous Kirschner Wire Internal Fixation and Open Kirschner Wire Internal Fixation in Children's Supracondylar Fractures of Humerus

目的：比较闭合复位经皮克氏针固定与开放复住克氏针固定治疗儿童肱骨髁上骨折的疗效。方法：回顾性分析闭合复位经皮克氏针固定与开放复住克氏针固定治疗儿童肱骨髁上骨折的临床效果。自2008年1月～2013年6月共治疗86例Gartland Ⅱ型和Ⅲ型儿童肱骨髁上骨折，有46例采用闭合复位经皮克氏针固定，有40例采用开放复位外侧克氏针交叉固定，随访6～40个月，比较术后Flynn肘关节功能评分和并发症发生率。结果：两组患儿均达到解剖复位，根据Flynn评分，肘关节功能满意度比较差异无统计学意义（P〉0．05）。闭合复住组并发症发生率为19．6％，包括克氏针松动移位2例、肘关节活动差3例、肘内翻2例、尺神经损伤2例；开放复位组并发症率为17．5％，包括切口感染1例，克氏针松动移位1例、肘关节活动差3例、肘内翻2例。两组并发症发生率比较差异无统计学意义（P〉0．05）。结论：闭合复位经皮克氏针固定术治疗儿童肱骨髁上骨折具有与开放复位术相同的临床疗效，但手术创伤较小，值得临床推广应用。

Objective： To compare the efficacy of closed percutaneous Kirschner wire internal fixation and open Kirschner wire internal fixation for supracondylar fractures of humerus in children. Methods：Retrospectivly analysed the clinical effect of closed percutaneous Kirsehner wire internal fixation and open Kirsehner wire internal fixation for supraeondylar fractures of humerus in children. 86 children with Gartland type Ⅱ and Ⅲ supraeondylar fractures of humerus who were treated from January 2008 to June 2013 and followed up for 6--40 months were divided into two groups. Of all, 46 patients were treated with closed percutaneous Kirschner wire internal fixation and 40 patients were treated with open Kirschner wire in- ternal fixation. Flynn elbow function scores and complication incidence after surgery were compared with those before treat- ment in both two groups. Results：According to Flynn scores, there was no significant difference between two groups in el- bow function satisfaction （P〉0. 05）, for both groups obtained anatomic reduction. The complication incidence rate of closed reduction group was 19.6 %, including Kirschner loosening in 2 cases, poor elbow activities in 3 cases, cubitus varus in 2 cases and ulnar nerve injury in 2 cases. The complication incidence rate of open reduction group was 17.5M, including surgical site infection in 1 case, Kirschner loosening in 1 case, poor elbow activities in 3 cases and ulnar nerve injury in 2 cases. There was no significant difference between two groups in incidence of complications （P〈0.05）. Conclusion：The clinical efficacy of closed percutaneous Kirsehner wire internal fixation and open Kirschner wire internal fixation for supracondylar fractures of humerus in children is similar, but the former has less surgical trauma which is worthy of clinical application.