GartlandⅢ型儿童肱骨髁上骨折的治疗方式探讨

Treatment methods for Gartland Ⅲ humeral supracondylar fracture in children

目的：探讨GartlandⅢ型儿童肱骨髁上骨折的治疗策略。方法将168例获随访GartlandⅢ型肱骨髁上骨折患儿按治疗方式进行分组，闭合复位组13例，闭合复位克氏针内固定组67例，切开复位内固定组88例。对3种治疗方法术后肘关节功能进行评价，观察并发症情况。结果患儿均获得随访，时间6～24个月。参照Flynn评定标准：闭合复位内固定组优于闭合复位组（χ2＝5.923，P＜0.01）；切开复位内固定组优于闭合复位组（χ2＝4.262，P＜0.01）；闭合复位内固定组与切开复位内固定组间差异无统计学意义（χ2＝0.354，P＞0.05）。结论对于Gartland Ⅲ型儿童肱骨髁上骨折，切开复位克氏针内固定在患儿的预后以及减少并发症方面不存在优势，在保证骨折复位的前提下治疗应首选闭合复位经皮克氏针内固定。

Objective To discuss the therapy option and prognosis for GartlandⅢhumeral supracondylar fracture in children.Methods 168 patients of Gartland Ⅲ humeral supracondylar fracture grouped by therapy method closed reduction group（CR）,13 cases;closed reduction and internal fixation group（CRI）,67 cases;open reduction and internal fixation group （ORI）,88 cases;were followed up to compare the difference of the prognosis by reduction and fixation type.Results All cases were followed up for 6-24 months.According to Flynn criteria,the prognosis of CRI group was better than CR group（χ2 =5.923,P〈0.01）and ORI group was better than CR group（χ2 =4.262,P〈0.01）,but no difference had been found between CRI and ORI group（χ2 =0.354,P〉0.05）.Conclusions Closed reduction and internal fixation seems the better choice for the treatment of Gartland Ⅲ fracture,ORI has no advantages on prognosis and complication.