手法整复经皮穿针治疗儿童GartlandⅢ型肱骨髁上骨折的病例对照研究

Case control study on the treatment of humerus supracondylar fracture of Gartland Ⅲ in children by manipulative reduction and Kirschner wire percataneous internal fixation

目的：探讨手法整复经皮闭合穿克氏针内固定治疗儿童GartlandⅢ型肱骨髁上骨折的临床疗效。方法：选择20lO年7月至2013年7月儿童GartlandIII型肱骨髁上骨折患者60例，分为治疗组及对照组。治疗组32例，其中男18例，女14例；年龄5-11岁，平均（7．8＋2．7）岁；采用传统“正骨十四法”手法整复经皮闭合穿克氏针固定。对照组28例，其中男16例，女12例；年龄4～12岁，平均（7．2±3．0）岁；采用切开复位克氏针内固定。观察和分析两组在肘关节屈伸活动范围、骨折临床愈合时间和术后6个月Flynm临床功能评定结果。结果：对照组骨折平均愈合时间（5．01±0．43）周，长于治疗组（4．29±0．29）周（t=7．49，P=0．00）。术后6个月治疗组患者肘关节活动范围（146．02＋2．28）°，明显大于对照组（140．76±4．42）°（t=-5．67，P=0．00）。术后6个月Flynn临床功能评定结果，对照组优7例，良16例，可4例，差1例；治疗组优21例，良9例，可2例（U=3．09，P=0．002）。结论：手法整复闭合穿针法治疗儿童GartlandIll型肱骨髁上骨折能明显缩短骨折临床愈合时间，临床疗效较好，值得推广。

To study the clinical effect of the GartlandⅢ humerus supracondylar fractures in children by ma- nipulative reduction and Kirschner wire percataneous internal fixation. Methods：From July 2010 and July 2013,60 patients with Gartland Ⅲ humerus supracondylar fracture were selected and divided into treatment group and control group. In the treatment group 32 patients were treated with traditional bone setting tetradeca-manipulative reduction and percataneous Kirschner wire internal fixation, included 18 males and 14 females with an average age of（7.8±2.7 ） years old ranging from 5 to 11 ;in the control group 28 patients were treated with open reduction and Kirschner wire internal fixation,included 16 males and 12 females with an average age of （7.2±3.0） years old ranging from 4 to 12. The motion range of the elbow joint ,the time of fracture clinical healing, and the effect after 6 months of Flynm clinical functional assessment standards were observed and compared. Results：The average fracture healing time of the control group （5.01±0.43） weeks was longer than that of the treat- ment group （4.29_＋0.29） weeks （t=7.49,P=0.00）. At 6 months after treatment,the elbow motion range of the treatment group （146.02±2.28） was more than that of the control group （140.76±4.42） （t=-5.67,P=0.00）. At 6 months after treatment, ac- cording to Flynn evaluation,in the control group, there were 7 cases as excellent, 16 as good,4 fair, 1 poor; in the treatment group, excellent in 21, good in 9, fair in 2 （U=3.09, P=0.002）. Conclusion：Manipulative reduction and Kirschner wire per- cataneous internal fixation for treatment of children＇s Gartland HI humerus condyle fractures can shorten fracture clinical heal- ing time and the clinical curative effect is better.