无血管神经损伤的儿童GartlandⅢ型肱骨髁上骨折不同手术时机的选择及疗效分析

Selection and curative effect of different surgical timing for Gartland type Ⅲ supracondylar fracture of humerus in children without vascular nerve injury

目的探讨并分析无血管神经损伤的儿童GartlandⅢ型肱骨髁上骨折不同手术时机的选择及临床疗效。方法选取我科收治的60例无血管神经损伤的儿童GartlandⅢ型肱骨髁上骨折患者进行前瞻性研究。采用随机数字表法将患者分为早期组和对照组,每组30例。早期组患者在损伤早期(<12 h)实施手术,对照组患者择期(>12 h)实施手术。比较2组手术时间、切开复位率、骨折愈合时间、肘关节功能恢复时间、住院时间及并发症发生率;采用视觉模拟量表(VAS)评分评估2组患者疼痛情况;采用Morrey肘关节功能评分评价2组患者肘关节功能恢复情况。结果2组切开复位率、手术时间、骨折愈合时间、肘关节功能恢复时间、住院时间比较差异无统计学意义(P>0.05)。2组术后3 d的VAS评分与术前比较差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05)。末次随访时2组Morrey肘关节功能评分比较差异无统计学意义(P>0.05)。2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论对于无血管神经损伤的儿童GartlandⅢ型肱骨髁上骨折,早期手术与延期手术均能获得满意的临床疗效。

Objective To explore and analyze the selection and clinical efficacy of different surgical timing for Gartland typeⅢsupracondylar fracture of humerus in children without vascular nerve injury.Methods A total of 60 children with Gartland typeⅢsupracondylar fracture of humerus without vascular nerve injury admitted to our department were selected for a prospective study.All patients were divided into the early group and the control group by random number table method,with 30 cases in each group.Patients in the early group underwent surgery at the early stage of injury(<12 hours),and patients in the control group underwent surgery at an elective period(>12 hours).The operation time,open reduction rate,fracture healing time,elbow joint function recovery time,hospitalization time and incidence of complications between the two groups were compared.The visual analogue scale(VAS)score was used to evaluate the pain of patients in the two groups;and the Morrey elbow joint function score was used to evaluate the recovery of elbow joint function of patients in the two groups.Results There was no statistically significant difference in the open reduction rate,operation time,fracture healing time,elbow joint function recovery time and hospitalization time between the two groups(P>0.05).There was a statistically significant difference in the VAS scores of the two groups 3 days after operation and that before operation(P<0.05),and there was no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference in the Morrey elbow joint function score between the two groups at the last follow-up(P>0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion For children with Gartland typeⅢsupracondylar fracture of humerus without vascular nerve injury,both early surgery and delayed surgery can obtain satisfactory clinical results.