克氏针固定术不同入路方式治疗小儿GartlandⅢ型肱骨髁上骨折的临床效果及其对肘关节功能的影响

Clinical effect of Kirschner wire fixation with different approaches in the treatment of supracondylar fracture of humerus of Gartland Ⅲ type in children and its effect on elbow joint function

目的探究克氏针固定术不同入路方式治疗小儿GartlandⅢ型肱骨髁上骨折的临床效果及其对肘关节功能的影响。方法选取2016年7月至2018年5月我院收治的80例GartlandⅢ型肱骨髁上骨折患儿为研究对象,根据入路方式的不同将80例患儿分为后入路组(39例,后入路克氏针固定术治疗)和侧入路组(41例,内外侧入路交叉克氏针固定术治疗)。比较两组患儿的术后并发症发生情况、骨折愈合时间、随访结束后患肢的Baumann角和提携角、肘关节活动度和肘关节功能恢复情况。结果侧入路组患儿术后并发症总发生率明显低于后入路组(P<0.05)。侧入路组患儿的骨折愈合时间明显短于后入路组(P<0.05)。随访结束后,侧入路组的Baumann角和提携角明显大于后入路组(P<0.05);侧入路组患儿患肢肘关节屈曲、背伸、旋前和旋后的活动度均明显大于后入路组(P<0.05);侧入路组患儿肘关节功能恢复优良率明显高于后入路组(P<0.05)。结论内外侧入路交叉克氏针固定术治疗小儿GartlandⅢ型肱骨髁上骨折效果显著,不仅可减少术后并发症发生情况,缩短骨折愈合时间,改善患儿的Baumann角和提携角,还可促进患肢肘关节功能的恢复,值得临床推广。

Objective To explore the clinical effect of Kirschner wire fixation with different approaches in the treatment of supracondylar fracture of humerus of Gartland Ⅲ type in children and its effect on elbow joint function. Methods Eighty children with supracondylar fracture of humerus of Gartland Ⅲ type admitted in our hospital from July 2016 to May 2018 were selected as the research objects. According to different approaches, 80 children were divided into posterior approach group (39 cases, treated with Kirschner wire fixation with posterior approach) and lateral approach group (41 cases, treated with Kirschner wire fixation with intersection of medial and lateral approach). The incidence of complications, fracture healing time, Baumann angle and carrying angle of affected limbs, elbow mobility and functional recovery of elbow joint after follow-up were compared between the two groups. Results The total incidence of postoperative complications in the lateral approach group was significantly lower than that in the posterior approach group (P<0.05). The fracture healing time of the lateral approach group was significantly shorter than that of the posterior approach group (P<0.05). After the follow-up, the Baumann angle and carrying angle of the lateral approach group were significantly larger than those of the posterior approach group(P<0.05);the mobility of motion of flexion, back extension, pronation and supination of elbow joints in the lateral approach group were significantly larger than those in the posterior approach group (P<0.05). The excellent and good rate of recovery of of elbow joint function in the lateral approach group was significantly higher than that in the posterior approach group (P<0.05). Conclusion Kirschner wire fixation with intersection of medial and lateral approach is effective in the treatment of supracondylar fracture of humerus of Gartland Ⅲ type in children. It can not only reduce the incidence of complications after operation, shorten the healing time of fracture, improve the Baumann angle and carrying angle of children, but also promote the recovery of elbow function of affected limbs, which is worthy of clinical promotion.