儿童肱骨髁上伸直型骨折屈肘旋前位固定的临床研究

The clinical study of plaster fixation in a position of elbow flexion and pronation in children′s extension-type supracondylar humeral fractures

目的评价屈肘旋前位石膏固定治疗肱骨髁上伸直型骨折预防肘内翻的临床疗效。方法收集2011年6月至2013年6月肱骨髁上骨折Mclntyre分型Ⅱ-Ⅲ型的患儿,分为屈肘旋前位石膏固定组（治疗组）和屈肘中立位石膏固定组（对照组）各30例。在复位后、随访期间及解除外固定3个不同时间段测量肘关节提携角（C角）及Baumann角（B角）,对比两组的肘内翻发生率,末次随访进行Flynn关节功能评分。结果 60例均获得随访,治疗组肘内翻发生率为6.67%（2/30）,对照组为13.33%（4/30）,两组比较,差异有统计学意义（P〈0.05）。随访期间,治疗组B角为（79.0±3.0）°、C角为（8.0±2.3）°,对照组B角为（80.0±2.7）°、C角为（9.0±5.2）°;至解除外固定时,治疗组B角为（80.0±2.5）°、C角为（6.0±3.5）°,对照组B角为（82.0±3.5）°、C角为（7.0±3.7）°;治疗组不同时间段组内比较,差异无统计学意义（P〉0.05）;对照组不同时间段组内比较,差异有统计学意义（P〈0.05）。在随访期间、解除外固定时间段,两组B、C角比较,差异有统计学意义（P〈0.05）。结论屈肘旋前位石膏固定治疗肱骨髁上伸直型骨折可有效降低肘内翻的发生率。

Objective To evaluate the clinic efficacy of plaster fixation with in a position of ebow flexion and pronation in children′ s extension-type supracondylar humeral fractures. Methods The patient children with Mclntyre type Ⅱ and Ⅲsupracondylar humeral fractures from June 2011 to June 2013 were collected and divided into the plaster fixation in a position of elbowflexion and pronation group and the plaster fixation in elbow flexion neutral position group,each of 30 cases. The treatment group was fixed the elbows in a position of flexion and pronation while the control group in flexed and neutral position. Carrying angle（C-angle） and Baumann angle（B-angle） were measured after post-reduction,during the follow-up and removing the plaster fixation. The rates of varus malunion were compared and Flynn elbow function scores were performed at the time of the latest fol-low-up. Results Among the follow-up 60 cases,the rates of varus malunion in the treatment group was 6.67%（2/30）while13.33%（4/30） in the control group. There was statistically significant difference between the two groups（P〉0.05）. During the fol low-up,B-angle was（79.0±3.0）° and C-angle was（8.0±2.3）° in the treatment group while B-angle was（80.0±2.7）° and C-angle was（9.0±5.2）°in the control group. When the plaster fixation was removed,B-angle was（80.0±2.5）°and C-angle was（6.0±3.5）° in the treatment group,B-angle was（82.0±3.5）°and C-angle was（7.0±3.7）° in the control group. There was no significant difference within the treatment group in different period of time（P〉0.05）,but significant difference within the control group in different period of time（P〉0.05）. Compared the degree of C-angle and B-angle of the two groups,tt had significant difference during the follow-up and plaster fixation removal（P〈0.05）. Conclusion The treatment of plaster fixation with in a position of ebow flexion and pronation in children′s extension-type supracondylar humeral fractures may reduce the rate of varus malunion.