闭合复位联合不同方式经皮克氏针内固定治疗肱骨髁上骨折的疗效与安全性评价

Effect and safety of closed reduction combinated with different ways Kirschner wire internal fixation on humeral supracondylar frature

目的：比较不同克氏针内固定方法治疗Gartland Ⅱ型儿童肱骨髁上骨折的临床疗效。方法：选取我科2011年1月～2013年12月间收治的肱骨髁上骨折患儿38例，C臂机下闭合复住后，均采用内侧小切口暴露尺神经后行内外侧交叉克氏针固定（观察组）；另外选取2008年1月-2010年12月收治的36例患儿作为对照组，均采用外侧平行2枚克氏针固定，术后予对症治疗和康复锻炼，患肢石膏固定，随访6～12个月，比较2组患儿肘关节功能评分和并发症的发生情况。结果：术后X线复查骨折解剖复位率观察组为96％（36／38），高于对照组89％（32／36），其差异有统计学意义（P〈0．05）。观察组Flynn评分优良率97％，对照组为95％，其差异无统计学意义（P〉0．05）。在并发症方面，观察组无1例发生肘内翻和医源性尺神经损伤，1例发生针道感染，经抗炎及换药治疗后缓解，总发生率为2．6％，对照组1例发生肘内翻，2例发生尺神经麻痹，1例出现针道感染，总发生率为11．1％，其差异有统计学意义（P〈0．05）。结论：内侧小切口暴露尺神经后内外侧交叉克氏针固定术可以有效降低尺神经损伤和肘内翻的发生率，并在直视下观察骨折块的形状，降低术后肘内翻的发生率，在小儿肱骨髁上骨折的治疗中有重要的作用。

Objective： To compare the different Kirschner wire internal fixation in the treatment of fractures of Gartland type II supra- condylar humerus. Methods： select 2011 January our department of condyle of humerus were treated between December -2013 year on fracture were in 38 cases, C ann machine after closed reduction, using medial incision after ulnar nerve and lateral cross Kirschner wire fixation （ observation group） ; the other selected from 2008 January -2010 year in December 36 cases as control group, with 2 lateral par- allel Kirschner pin fixation, postoperative symptomatic treatment and rehabilitation exercise, limb plaster fixation, the follow - up of 6 - 12 months, occurred in two groups were compared the elbow function score and complications. Results： The anatomic reduction rate was 96% in the observation group fracture X -ray examination after operation （36/38）, 89% more than that of control group （32/36）, the difference was statistically significant （p 〈 0.05 ）. The observation group Flynn score the excellent and good rate was 97%, 95% in the control group, the difference was not statistically significant （ p 〉 0. 05 ）. The complications, the observation group with no occurrence of cubitus varus and iatrogenic ulnar nerve injury, pin tract infection occurred in 1 cases, the anti - inflammatory and dressing change thera- py, the total incidence rate （2.6%）, the control group of 1 cases of cubitus varus, 2 cases of ulnar nerve palsy, pin tract infection in 1 cases, the total incidence rate （ 11.1% ）, the difference was statistically significant （ p 〈 0.05 ）. Conclusion： the medial incision after ulnar nerve and lateral cross Kirschner wire fixation can effectively reduce the injury of the ulnar nerve and the incidence of cubitus varus, and to observe the fracture block shape under direct vision, reduce the postoperative incidence of cubitus varus, plays an important role in the treatment of children humeral supracondylar fracture in.