杨氏手法复位环形垫超肘夹板“8”字固定治疗儿童移位型肱骨外髁骨折的临床研究

A clinical study of Yang’s manipulative reduction combined with figure-of-eight fixation with ring-shaped pads and transarticular splints for treatment of displaced humeral lateral condyle fractures in children

目的:观察杨氏手法复位环形垫超肘夹板“8”字固定治疗儿童移位型肱骨外髁骨折的临床疗效和安全性。方法:以2017年3月至2018年11月在湘潭市中医医院住院治疗的JacobⅡ、Ⅲ型肱骨外髁骨折患儿为研究对象。采用随机数字表将符合要求的患者随机分为非手术组和手术组。非手术组采用杨氏手法复位环形垫超肘夹板“8”字固定治疗,手术组采用切开复位克氏针内固定加石膏外固定治疗。观察记录患者的双侧肘关节周径差、住院时间、治疗费用、骨折愈合情况及Baumann角,采用Broberg-Morrey肘关节评分量表评定总体疗效。同时观察记录治疗及随访期间的并发症发生情况。结果:共纳入60例患者,非手术组和手术组各30例。2组患者的双侧肘关节周径差总体比较,组间差异无统计学意义,即不存在分组效应(F=8.325,P=0.522)。时间因素和分组因素存在交互效应(F=26.140,P=0.000)。治疗前后不同时点间双侧肘关节周径差的差异有统计学意义,即存在时间效应(F=19.060,P=0.000);2组患者的双侧肘关节周径差随时间变化均呈降低趋势,但2组的降低趋势不完全一致(F=11.070,P=0.000;F=25.100,P=0.000);治疗前和治疗后28 d,2组患者的双侧肘关节周径差比较,组间差异均无统计学意义[(7.00±0.50)cm,(6.80±0.53)cm,t=1.456,P=0.156;(0.90±0.19)cm,(1.00±0.21)cm,t=-0.783,P=0.440];治疗后7 d、14 d时,非手术组的双侧肘关节周径差均小于手术组[(3.10±0.47)cm,(4.30±0.73)cm,t=6.111,P=0.000;(1.00±0.21)cm,(1.10±0.24)cm,t=-2.431,P=0.021]。与手术组相比,非手术组的住院时间短、治疗费用低[(6.00±1.03)d,(8.80±1.71)d,t=-8.015,P=0.000;(2621.40±304.93)元,(8061.70±766.67)元,t=-37.917,P=0.000]。2组患者的骨折均愈合良好,未发生骨折延迟愈合或不愈合。治疗后6个月时,2组患者的Baumman角、Broberg-Morrey评分比较,组间差异均无统计学意义[3.20°±0.34°,3.30°±0.37°,t=-1.086,P=0.287;(92.10±2.36)分,(92.60±1.96)分,t=-0.916,P=0.367]。2组患者治疗及随访期间均未出现并发症。结论:杨氏手法复位环形垫超肘夹板“8”字固定是治疗儿童移位型肱骨外髁骨折的有效方法,其疗效和安全性与切开复位克氏针内固定治疗相当;但与切开复位克氏针内固定治疗相比,治疗后患肢肿胀消退更快、住院时间更短、治疗费用更低。

Objective:To observe the clinical curative effects and safety of Yang’s manipulative reduction combined with figure-of-eight fixation with ring-shaped pads and transarticular splints for treatment of displaced humeral lateral condyle fractures in children.Methods:The children with Jacob type Ⅱ and Ⅲ humeral lateral condyle fractures who were treated in Xiangtan Hospital of Traditional Chinese Medicine from March 2017 to November 2018 were selected as the subjects.Sixty children were enrolled in the study and were randomly divided into operative group and non-operative group by using random digits table,30 cases in each group.The children in non-operative group were treated with Yang’s manipulative reduction combined with figure-of-eight fixation with ring-shaped pads and transarticular splints,while the children in operative group were treated with open reduction combined with Kirschner wire internal fixation and plaster external fixation.The difference of circumference between bilateral elbow joints,hospital stays,cost of treatment,fracture healing and Baumann angles were observed and recorded respectively,and the total clinical curative effects were evaluated by using Broberg-Morrey elbow scoring scale.Meanwhile,the complication incidences were observed and recorded during the treatment and follow-up period.Results:In general,there was no statistical difference between the 2 groups in the difference of circumference between bilateral elbow joints,in other words,there was no group effect(F=8.325,P=0.522).There was interaction between time factor and group factor(F=26.140,P=0.000).There was statistical difference in the difference of circumference between bilateral elbow joints between different timepoints before and after treatment,in other words,there was time effect(F=19.060,P=0.000).The difference of circumference between bilateral elbow joints presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(F=11.070,P=0.000;F=25.100,P=0.000).There was no statistical difference in the difference of circumference between bilateral elbow joints between the 2 groups before the treatment and at 28 days after the treatment(7.00+/-0.50 vs 6.80+/-0.53 cm,t=1.456,P=0.156;0.90+/-0.19 vs 1.00+/-0.21 cm,t=-0.783,P=0.440).The difference of circumference between bilateral elbow joints was less in non-operative group compared to operative group at 7 and 14 days after the treatment(3.10+/-0.47 vs 4.30+/-0.73 cm,t=6.111,P=0.000;1.00+/-0.21 vs 1.10+/-0.24 cm,t=-2.431,P=0.021).The cost of treatment was lower and the hospital stay was shorter in non-operative group compared to operative group(2621.40+/-304.93 vs 8061.70+/-766.67 RMB,t=-37.917,P=0.000;6.00+/-1.03 vs 8.80+/-1.71 days,t=-8.015,P=0.000).All fractures healed well,and no delayed union and nonunion of fractures were found in the 2 groups.There was no statistical difference in Baumann angles and Broberg-Morrey scores between the 2 groups at 6 months after the treatment(3.20+/-0.34 vs 3.30+/-0.37 degrees,t=-1.086,P=0.287;92.10+/-2.36 vs 92.60+/-1.96 points,t=-0.916,P=0.367).No complications were found in the 2 groups during the treatment and follow-up period.Conclusion:Yang’s manipulative reduction and figure-of-eight fixation with ring-shaped pads and transarticular splints is effective for treating displaced humeral lateral condyle fractures in children,and it is similar to open reduction and Kirschner wire internal fixation in clinical curative effects and safety,while the former has such advantages as faster posttreatment swelling subsidence in affected limbs,shorter hospital stays and lower cost of treatment compared to the latter.