两种手术方式治疗儿童Ⅲ型肱骨髁上骨折的疗效对比

Comparison of Curative Effect of Two Surgical Methods for Treatmenting of Gartland Ⅲ Type of Supracondylar Humerus Fracture in Children

目的：研究切开复位内固定术与闭合复位内固定术治疗儿童Ⅲ型肱骨髁上骨折的疗效。方法：回顾性分析2011年6月-2014年6月本院诊治的儿童Ⅲ型肱骨髁上骨折患者,所接受的治疗分为切开组（切开复位内固定术组）和闭合组（闭合复位内固定术组）。其中切开组110例,闭合组101例;男129例,女82例;年龄1-13岁,平均5.4岁;术后平均随访24.2个月（6-36个月）。所有患者都是在全麻下进行,手术由同一个医师完成。肘关节功能根据Flynn评价标准对两组于术后4,8,16周进行功能评定,同时对两组的术中出血、手术时间、骨折愈合时间与肘关节活动功能恢复时间比较分析。结果：切开组和闭合组Flynn功能评定,术后4周（P=0.649）,8周（P=0.978）,16周（P=0.935）差异无统计学意义,两组骨折愈合时间对比（P〉0.05）及肘关节活动功能恢复时间均无统计学意义（P〉0.05）,但是在术中出血和手术时间方面差异有统计学意义（P〈0.01）。结论：切开与闭合复位内固定术对治疗肱骨髁上骨折都有效果,手术时可优先行闭合复位内固定术,再考虑切开复位内固定术。

Objective： To observe the curative effect of open reduction fixation and internal fixation with closed reduction for treating of Gartland Ⅲ type of supracondylar humerus fracture in children. Methods.. Retrospective analyzed 211 children with Gartland Ill type of supracondylar humerus fracture in the Fuzhou second hospital from June 2011 to June 2014. They were divided into open reduction fixation group （n= 110） and internal fixation with closed reduction group （n= 101）. There were 129 male and 82 female, aged 1 to 13 years old （5.4 years old averagely）. They were followed-up for 6 to 36 months （24.2 months averagely）. All patients were performed under general anesthesia, and the surgery was performed by the same one surgeon. The elbow joint function was evaluated according to Flynn evaluation criteria in the two groups 4 weeks, 8 weeks, and 16 weeks after surgery. The amount of bleeding, the operation time, the fracture healing time, and the function recovery time of elbow joint were compared between the two groups. Results.. All children achieved union in a mean time of 4 weeks （range： 3-6 weeks）. The Flynn evaluation was not significantly different between the two gropus al 4th, 8th, and 16th weeks after surgery （P=0.649,P=0.978,P=0.935 respectively）. The fracture healing time and the function recovery time of elbow joint was not significantly different between the two gropus （P〉0.05）, but the amount of bleeding and the operation time was significantly different （P〈0.01）. Conclusion： The open reduction fixation and internal fixation with closed reduction are both effective for treating Gartland III type of supracondylar humerus fracture in children. It is priority to consider the internal fixation with closed reduction, and then the open reduction fixation.