三种手术方法治疗儿童GartlandⅢ型肱骨髁上骨折

Three surgical techniques in the treatment of Gartland typeⅢsupracondylar humeral fractures in children

目的探讨三种手术方法治疗儿童GartlandⅢ型肱骨髁上骨折的疗效。方法自2017年1月至2017年9月采用克氏针(16例)、弹性钉(19例)、外固定(21例)治疗儿童GartlandⅢ型肱骨髁上骨折共56例,均行骨折闭合复位并固定成功,术后定期复查指导功能锻炼。比较3组患儿术后4周、12周和1年时的肘关节活动范围,比较患侧提携角的差异。以Flynn肘关节评分评价患儿肢体功能和外观恢复情况。结果外固定组的手术时长和曝光次数较少;克氏针组的整复次数较多。外固定组的肘关节活动度在术后4周和12周时优于其他2组。术后1年时3组病例在肘关节屈曲上差异无统计学意义;在肘关节伸直上,弹性钉组功能评分17例为优,2例为良;克氏针组14例为优,2例为良;外固定组均为优。克氏针组和外固定组各有15例(93.8%)和20例(95.2%)外观评分为优,各有1例为良,弹性钉组均为优。3组病例的肘关节功能及外观优良率差异无统计学意义。结论三种手术方法在儿童GartlandⅢ型肱骨髁上骨折的治疗中各具优势,疗效相当,术者应根据自身技术水平和患儿病情加以选择。

Objective To investigate the clinical efficacy of three surgical techniques for Gartland typeⅢsupracondylar humeral fractures in children.Methods From January 2017 to September 2017,56 children with Gartland typeⅢsupracondylar humeral fractures were treated with Kirschner wire(16 cases),elastic nail(19 cases)and external fixation(21 cases).All the patients were performed close reduction and successful fixation.After operation,regular reexamination was conducted to guide functional exercise.The range of motion of elbow joint and the difference of carrying angle in affected side of the three groups were compared at 4 weeks,12 weeks and 1 year after operation.Flynn elbow joint score was used to evaluate the recovery of limb function and appearance.Results In the external fixation group,the operation time and exposure times were less;while in the Kirschner wire group,the reduction times were more.The elbow joint mobility of external fixation group was better than other two groups at 4 and 12 weeks after operation.One year after operation,there was no significant difference in elbow flexion between the three groups;in elbow extension,the function score of elastic nail group was excellent in 17 cases,good in 2 cases;Kirschner wire group was excellent in 14 cases,good in 2 cases;external fixation group was excellent in all cases.15 cases(93.8%)and 20 cases(95.2%)in the Kirschner wire group and the external fixation group had excellent appearance scores,1 case was good in each group,and the elastic nail group was excellent.There was no significant difference in the function and appearance of elbow joint between the three groups.Conclusion The three surgical methods have their own advantages in the treatment of Gartland typeⅢsupracondylar humeral fractures in children,and the clinical efficacy is equivalent.The operator should choose the suigical method according to his own technical level and the condition of the child.