急诊与有限择期闭合复位穿针固定治疗GartlandⅡ型及Ⅲ型儿童肱骨髁上骨折的比较

Comparative study on emergency treatment and selective closed reduction and percutaneous pin fixation for hu- meral supracondylar fracture of Gartland type Ⅱ and type Ⅲ in children

目的比较急诊与有限择期闭合复位单纯外侧经皮克氏针固定治疗儿童GartlandⅡ型、Ⅲ型肱骨髁上骨折的疗效。方法将2010年3月至2012年3月在咸阳市中心医院就诊的新鲜的60例GartlandⅡ型、Ⅲ型肱骨髁上骨折的患儿采用随机抽取编号法分为2组，A组选择在伤后8h内急诊手术，手术方法采用闭合复位，单纯外侧经皮克氏针固定。B组先行石膏固定，待伤后3～5d再行闭合复位穿针固定术，观察2组的手术时间、术中透视次数，术后肿胀、疼痛时间及住院费用等。结果A组手术时间（18．5±12．3）min，B组手术时间（20．1±15．3）min，2组手术时间比较差异有统计学意义（P〈0．05）。A组平均透视6．2次，B组平均透视7．3次，2组平均透视次数差异有统计学意义（P〈0．05）。B组肿胀指数在伤后3d、5d、7d时高于A组，差异有统计学意义（P均〈0．05）。伤后疼痛时间B组为（5．26±1．36）d，高于A组[（3．44±1．23）d]。神经功能恢复时间A组为（36．5±7．0）d，B组为（36．2±7．0）d，2组比较差异无统计学意义（P〉0．05）。A组住院时间及费用少于B组，差异有统计学意义（P〈0．05），最终2组患儿的肘关节功能比较差异无统计学意义（P〉0．05）。结论急诊闭合复位单纯外侧经皮克氏针固定治疗儿童GartlandⅡ型、Ⅲ型肱骨髁上骨折，围术期反应轻，疼痛时间短，住院时间短，费用少，术后肘关节功能良好。

Objective To investigate the curative efficacy of fracture with closed reduction and percutaneous Kirschner wire fixation of the simple lateral injury for humeral supracondylar fracture of Gartland type Ⅱ and type Ⅲ in children by the emergency treatment and selective surgery. Methods From March 2010 to March 2012, sixty children with Gartland type Ⅱ and type Ⅲ fresh humeral supracondylar fracture were operated in Xianyang Center Hospital. Six- ty children were randomly divided into two groups：group A by emergency operation 8 hours after injury with closed re- duction method and lateral percutaneous Kirschner wire fixation only, group B initially treated with plast fixation, then undergoing surgery after 3 - 5 days of injury with the closed reduction and percutaneous pin fixation. The operation du- ration, frequency of intraoperative image intensifier, postoperative swelling, pain lasting time after injury and hospitaliza- tion cost were investigated in two groups. Results The average operation duration of group A was （ 18.5 ± 12.3 ） min, and that in group B was （20.1 ± 15.3 ） rain, and there was a statistically significant difference between two groups（ P 〈 0.05 ）. The frequency of intraoperative image intensifier was 6.2 times on the average in group A, but 7.3 times in group B, and there was a statistically significant difference between two groups （ P 〈 0.05 ）. The postoperative swelling rate on 3,5,7 days after injury in group B was significantly higher than that of group A, and there was a statistically sig- nificant difference（ all P 〈 0.05 ）. The duration of pain after injury in group A was （ 3.44 ± 1.23 ） days, but （ 5.26 ± 1.36 ） days in group B, which was significantly different ; the nerve function recovery time of group A was （ 36.5 ± 7.0） d, and it was（ 36.2 ± 7. 0） d in group B, which was not significantly different （P 〉 0.05 ）. The average hospitalization time and cost in group A was less than that in group B, which was significantly different （ P 〈 0.05 ）. Finally there was no statistically significant difference in elbow joint function between two groups of children （ P 〉 0.05 ）. Conclusions The emergency operation of closed reduction and percutaneons Kirschner wire fixation for the treatment of simple lateral injury in children with Gartland type Ⅱ and type Ⅲ fracture has the advantages over the selective surgery, including shorter operation time, less contact of X - ray intraoperatively,light postoperative swelling, short duration of pain in chil- dren, as well as the shortened hospitalization time, reduced costs, especially good efficacy for joint function recovery.