三种复位方法对GartlandⅡ型和Ⅲ型儿童肱骨髁上骨折的近期疗效及肘内翻畸形的影响

Short-term Curative Effect of Three Reduction Methods on Gartland Type Ⅱ and Type Ⅲ Supracondylar Fracture of Humerus in Children and the Influence on Cubitus Varus Deformity

目的:探讨三种复位方法(手法复位石膏外固定、切开复位克氏钉内固定、手法复位经皮克氏钉内固定)对GartlandⅡ~Ⅲ型儿童肱骨髁上骨折的近期疗效及肘内翻畸形的影响。方法:回顾性分析2017年1月-2019年5月笔者医院收治的166例GartlandⅡ~Ⅲ型儿童肱骨髁上骨折患儿。根据患儿的固定复位治疗方案分为3组,50例患儿采用手法复位石膏外固定纳入A组,61例患儿采用切开复位克氏钉内固定纳入B组,55例患儿采用手法复位经皮克氏钉内固定纳入C组。比较三组患儿的骨折愈合时间、肘关节屈伸功能、Baumann角和提携角、肘内翻畸形发生率。结果:三组患儿骨折愈合时间比较差异无统计学意义(P>0.05)。B、C两组患儿的肘关节屈伸功能均优于A组、Baumann角均小于A组,提携角均大于A组,差异均有统计学意义(P<0.05)。B、C两组患儿的肘内翻畸形发生率分别为8.20%和7.27%,均小于A组的22.00%,差异有统计学意义(P<0.05)。B组和C组的肘关节屈伸功能程度、Baumann角和提携角、肘内翻畸形发生率比较差异均无统计学意义(P>0.05)。结论:GartlandⅡ~Ⅲ型儿童肱骨髁上骨折采用克氏钉内固定效果优于石膏外固定,对患儿肘关节屈伸功能受限和肘内翻畸形的影响较小,克氏钉内固定选用切开复位还是手法复位疗效相当。

Objective To investigate the short-term curative effect of three reduction methods(manual reduction and plaster external fixation,open reduction and Kirschner screw internal fixation,manual reduction and percutaneous Kirschner screw internal fixation)on supracondylar fracture of humerus in children and the influence on cubitus varus deformity.Methods A retrospective analysis was conducted.166 children with GartlandⅡ-Ⅲtype supracondylar fracture of humerus who were admitted to the hospital from January 2017 to May 2019 were enrolled in the study.According to the reduction and fixation method,the children were divided into 3 groups.50 children treated with manual reduction and external fixation were included in group A,61 children treated with open reduction and Kirschner screw internal fixation were included in group B,and 55 children treated with manual reduction and percutaneous Kirschner screw internal fixation were included in group C.The fracture healing time,elbow flexion and extension function,Baumann angle and carrying angle,and incidence of cubitus varus deformity were compared among the three groups.Results There was no significant difference in fracture healing time among the three groups(P>0.05).The elbow flexion and extension function in group B and group C group was better than that in group A,Baumann angles of group B and group C were smaller than those in group A,and carrying angles were larger than group A,the difference were statistically significant(P<0.05).The incidence of cubital varus deformity in group B and group C(8.20%and 7.27%)were lower than 22.00%in group A(P<0.05).There was no significant difference in elbow flexion and extension,Baumann angle,carrying angle or the incidence of cubitus varus deformity between group B and group C(P>0.05).Conclusion The effect of Kirschner screw internal fixation is better than that of plaster external fixation in the treatment of children with GartlandⅡ-Ⅲtype supracondylar fracture of humerus.It has little effect on flexion and extension of elbow joint and elbow varus deformity.The effects of open reduction and manual reduction in Kirschner screw internal fixation are equivalent.