不同软组织肿胀情况下两种方法治疗GartlandⅢ型儿童肱骨髁上骨折的效果比较

Comparison of two methods therapeutic effects for Gartland Ⅲ humeral supracondylar fracture in children with different soft tissue swelling conditions

目的比较不同软组织肿胀情况下闭合复位内固定与切开复位内固定方式治疗Gartland Ⅲ型儿童肱骨髁上骨折的效果．探讨软组织情况对于治疗方式选择及预后的影响。方法回顾分析2008年1月-2013年12月于宁波市第六医院采用闭合复位内固定或切开复位内固定方式治疗。年龄在7～11岁并得到随访6～24个月（平均11个月）的Gartland Ⅲ型肱骨髁上骨折患儿155例。按治疗时软组织肿胀情况分为轻度肿胀组和中、重度肿胀组．参照Flynn肱骨髁上骨折疗效评定标准，比较不同软组织条件下两种治疗方式对骨折预后的影响。结果155例根据骨折软组织肿胀情况分组：轻度肿胀组41例，采用闭合复位内固定39例，其中优35例，良4例，优良率为100％；切开复位2例，优1例，良1例，优良率100％。中、重度肿胀组114例，采用闭合复位内固定28例，其中优7例，良16例，可4例，差1例，优良率为82．1％；切开复位86例，优50例，良27例，可8例，差1例，优良率为89．5％。在中、重度肿胀组，两种治疗方式间疗效差异有统计学意义（X2=9．549，P=0．023）。结论对于Gartland Ⅲ型肱骨髁上骨折，软组织肿胀程度直接影响预后，在明显肿胀发生前采用闭合复位的方式可以得到较好的疗效．对于软组织已经明显肿胀的病例切开复位的方式效果会更好，而不是等待骨形态重塑或截骨矫形治疗。

Objective To compare the treatment effects of open or closed reduction for Gartland m humeral supracondylar fracture in children with different soft tissue swelling degrees, to discuss the influence of soft tissue condition on treatment method selection. Methods 155 patients with Gartland Ⅲ humeral supracondylar fracture aged 7-11, followed up 6-24 months, treated in the Sixth Hospital of Ningbo City from January 2008 to December 2013 were selected. The patients were divided into mild swelling group and moderate and severe swelling group by soft tissue swelling degrees. According to Flynn criteria, the treatment effects of closed reduction with internal fixation and open reduction with internal fixation were compared between groups. Results 155 patients were divided into mild group （41 cases） or moderate and severe swelling group （114 cases）. In the mild group, 39 cases were given closed reduction with internal fixation, among whom 35 cases were excellent, 4 cases were good, the excellent and good rate was 100%. 2 cases were giv- en open reduction with internal fixation, among whom 1 case was excellent, 1 case was good, the excellent and good rate was 100%. In the moderate and severe swelling group, 28 cases were given closed reduction with internal fixation, among whom 7 cases were excellent, 16 cases were good, 4 cases were better, 1 case was poor, the excellent and good rate was 82.1%. 86 cases were given open reduction with internal fixation, among whom 50 cases were excellent, 27 cases were good, 8 cases were better, 1 case was poor, the excellent and good rate was 89.5%. The difference in curative effect between the two treatment methods in moderate and severe swelling group was statistically significant （X2= 9.549, P = 0.023）. Conclusion The prognosis of the Gartland m fracture is affected by elbow swelling degree, closed reduction with internal fixation is enough for mild swelling group. For moderate and severe swelling patients open reduction and internal fixation is a better choice than waiting for the remodeling or supracondylar osteotomy.