儿童开放性肱骨髁上骨折与Gartland Ⅲ型肱骨髁上骨折的临床治疗效果

Closed versus open supracondylar fractures of the humerus in children: a comparison of therapeutic effect

目的比较儿童开放性与GartlandⅢ型肱骨髁上骨折的临床治疗效果,探讨儿童开放性肱骨髁上骨折的治疗方法。方法回顾性分析2011年6月至2019年6月我院收治并随访的19例开放性肱骨髁上骨折患儿,随机筛选同期的38例GartlandⅢ型肱骨髁上骨折患儿,比较两者的临床治疗结果。开放性肱骨髁上骨折患儿入院后及早静脉滴注抗生素。GustiloⅢ型及Ⅱ型儿童开放性肱骨髁上骨折行急诊手术治疗,GustiloⅠ型儿童开放性肱骨髁上骨折予以局部消毒包扎、手法复位及石膏临时固定,行急诊或亚急诊手术治疗。GartlandⅢ型肱骨髁上骨折均行手法复位及石膏临时固定,限期内手术治疗。比较术前住院时间、合并损伤情况、手术时间、术后感染及术后功能恢复等。结果两组患儿的年龄、性别没有显著性差异,术后随访时间6~27个月,平均19个月。GustiloⅠ型儿童开放性肱骨髁上骨折手术时间平均为(35.18±4.67)min,GartlandⅢ型肱骨髁上骨折手术时间平均为(40.77±2.68)min,差异无统计学差异(P=0.273);GustiloⅡ型骨折手术时间平均为(41.25±5.15)min,较GartlandⅢ型肱骨髁上骨折手术时间长,但差异无统计学意义(P=0.063);GustiloⅢ型骨折手术时间为1~6 h,平均(200.00±61.64)min,较GartlandⅢ型肱骨髁上骨折手术时间长,差异有统计学意义(P=0.037)。GartlandⅢ型肱骨髁上骨折术后感染率为2.6%,开放性肱骨髁上骨折患儿术后感染发生率为5.3%,差异无统计学意义(χ^(2)=0.259,P=0.611)。GartlandⅢ型肱骨髁上骨折患儿神经损伤发生率为28.9%,开放性肱骨髁上骨折患儿神经损伤发生率为42.1%,差异无统计学意义(χ^(2)=0.987,P=0.321),所有神经损伤病例随访6个月均恢复。末次随访时Flynn评分:GartlandⅢ型肱骨髁上骨折患儿优36例(94.7%),良2例(5.3%);开放性骨折患儿优16例(84.2%),良3例(15.8%);两者差异无统计学意义(χ^(2)=1.754,P=0.185)。结论儿童开放性肱骨髁上骨折在经过抗菌药物治疗、软组织清创、骨折有效固定等确切治疗后,与GartlandⅢ型肱骨髁上骨折相比,总体治疗效果相似。

Objective To compare the presentation and postoperative results of children treated for open and Gartland typeⅢsupracondylar fractures of the humerus.Methods From June 2011 to June 2019,19 patients with open and 38 patients with Gartland typeⅢsupracondylar fractures of the humerus were evaluated.Intravenous antibiotics were used for open supracondylar fracture patients as early as possible.Patients with Gustilo typesⅢandⅡopen supracondylar fracture of the humerus were treated by emergency operation.Gustilo typeⅠopen supracondylar fracture patients were treated by disinfection,bandage,reduction,temporary plaster fixation,emergency or sub emergency operation.Gartland typeⅢsupracondylar fracture patients were treated by reduction,temporary plaster fixation,and operation within the time limit.The wound characteristics,combined injuries,operation timing,operation time,clinical efficacy,and complications were analyzed.Results The two groups were similar with respect to age and sex.All the patients were followed for 6-27 months,with an average of 19 months.The mean operative time of Gustilo typeⅠpatients was(35.18±4.67)min,and that of Gartland typeⅢpatients was(40.77±2.68)min;the difference between them was not statistically significant(P=0.273).The mean operative time of Gustilo typeⅡpatients was(41.25±5.15)min,which was longer than that of Gartland typeⅢpatients,but with no statistically significant difference(P=0.063).The mean operative time of Gustilo typeⅢpatients was(200.00±61.64)min,which was longer than that of Gartland typeⅢpatients(P=0.037).The incidence of postoperative infection was 5.3%in open fracture patients and 2.6%in Gartland typeⅢpatients,and the difference between them was not statistically significant(χ^(2)=0.259,P=0.611).The incidence of nerve injury was 28.9%in Gartland typeⅢpatients and 42.1%in open fracture patients,and there was no significant difference between them(χ^(2)=0.987,P=0.321).At the last follow-up,36 cases(94.7%)achieved excellent results and 2 cases(5.3%)achieved good results in Gartland typeⅢpatients and the corresponding figures in open fracture patients were 16(84.2%)and 3(15.8%),respectively,there was no significant difference between them(χ^(2)=1.754,P=0.185).Conclusion Open supracondylar fracture of the humerus in children can be cured with antibiotics,timely debridement,and effective fixation.The treatment effect of open supracondylar fractures of the humerus in children is similar to that of Gartland typeⅢsupracondylar fractures.The therapeutic effect is excellent.