小儿轻度移位JakobⅡ型肱骨外髁骨折治疗方法研究

Treatment of the Minimal Displaced JakobⅡ Classification Humerus Lateral Condylar Fractures in Children

目的比较小儿轻度移位JakobⅡ型肱骨外髁骨折保守治疗与手术治疗的疗效及预后。方法选取2010年10月—2012年10月本院收治并有完整资料的轻度移位JakobⅡ型单纯肱骨外髁骨折患儿32例,平均移位(2.3±0.3)mm。其中16例(A组)采取切开复位克氏针内固定治疗,10例(B组)采取闭合复位克氏针固定治疗,6例(C组)采取石膏固定保守治疗。平均随访时间12个月。根据Hardacre标准判断疗效,并比较3组并发症发生率。结果治疗1年后,A组疗效优15例(93.8%)、良1例(6.2%)、差0例;B组优9例(9/10)、良1例(1/10)、差0例;C组优3例(3/6)、良2例(2/6)、差1例(1/6),其中C组患儿疗效较A组差(P<0.05)。3组患儿均未见鱼尾样畸形、骨折不愈合和肱骨小头无菌性坏死。C组肱骨外髁过度生长发生率(6/6)均高于A组〔37.5%(6/16)〕、B组〔40.0%(4/10)〕(P<0.016 7)。结论小儿轻度移位JakobⅡ型肱骨外髁骨折建议积极手术治疗,切开复位克氏针内固定与闭合复位克氏针内固定长期随访预后无差异。石膏固定保守治疗风险较大。

Objective To compare the curative effect and prognosis of conservative treatment and operative treatment in treatment of minimal displaced JakobⅡ classification humerus lateral condylar fractures in children. Methods A total of 32 children with minimal displaced JakobⅡ classification lateral condylar fractures who were treated in our hospital from October 2010 to October 2012,were selected as study subjects,their medical record materials were complete,the average displacement degree was（2. 3 ±0. 3）mm. 16 cases（A group）were treated with open reduction and kirschner wire internal fixation,10 ca-ses（ B group）were treated with closed reduction and kirschner wire internal fixation,the rest 6 cases（ C group） were treated with nonoperative treatment with application of plaster. All patients were followed up,with the mean follow -up interval of 12 months. Curative effects were assessed using the criteria suggested by Hardacre. The complication rates were compared among 3 groups. Results 1 year after treatment,for A group,15 cases（93. 8%）had excellent effect,1 case（6. 2%）had good effect,and 0 had poor effect;For B group,9 cases（9/10）had excellent effect,1 case（1/10）had good effect,and 0 had poor effect;For C group,3 cases（3/6）had excellent effect,2 cases（2/6）had good effect,and 1 case（1/6）had poor effect,the curative effect in C group was worse than that in A group（P〈0. 05）. Fish tale style malformation,fracture nonun-ion and aseptic necrosis of capitulum humeri were not found in 3 groups of children. The incidence of humeral ectocondyle over-growth in C group（6/6）was significantly higher than that in A group〔37. 5%（6/16）〕and that〔40. 0%（4/10）〕in B group（P〈0. 016 7）. Conclusion It is recommended that children with minimal displaced JakobⅡclassification lateral condy-lar fractures receive operative treatment,there is no significant difference in long-term follow-up prognosis between open re-duction plus kirschner wire internal fixation and closed reduction plus kirschner wire internal fixation. Nonoperative treatment with application of plaster has greater risk.