儿童Gartland Ⅱ型肱骨髁上骨折保守治疗和手术治疗的效果比较

Comparison of conservative and surgical treatment for Gartland typeⅡsupracondylar humeral fracture in children

目的比较保守治疗和手术治疗儿童GartlandⅡ型肱骨髁上骨折的效果。方法回顾性分析2015年1月至2018年12月在海口市妇幼保健院接受治疗的41例GartlandⅡ型肱骨髁上骨折患者的临床资料,平均年龄(5.4±2.2)岁,根据治疗方式分为两组:保守治疗组(A组,17例)和手术治疗组(B组,24例)。两组患者年龄、性别、侧别以及术后随访时间均无显著差异。于末次随访时测量患侧肘关节的过伸角、屈曲角、屈伸活动范围(range of motion,ROM)、提携角。在X线正位片上测量Baumann角,并在侧位片上评价肱骨前缘连线是否通过肱骨小头的中1/3。采用上肢快速功能障碍量表对肘关节功能进行评分,根据Flynn肘关节临床功能评分标准评定疗效。结果末次随访时,平均过伸角、屈曲角、ROM、提携角和Baumann角分别为(9.1±6.6)°、(139.2±6.7)°、(152±6.3)°、(8.4±5.9)°和(77.6±5.8)°。A、B两组的过伸角、屈曲角、ROM、提携角、Baumann角均无差异(P>0.05)。A组中有11例(64.7%)肱骨前缘连线通过肱骨小头中1/3(11例,64.7%),明显少于B组(22例,91.7%),差异有统计学意义(P=0.049)。末次随访时平均QuickDash评分为(1.5±2.1)分,两组QuickDash评分差异无统计学意义(t=0.750,P=0.458)。根据Flynn肘关节临床功能评分标准,A组优良率为94.1%(16/17),B组优良率为91.7%(22/24),差异无统计学意义(P>0.05)。A组有1例(5.9%)发生肘内翻;B组除1例(4.2%)发生肘内翻以外,1例(4.2%)发生尺神经损伤和1例(4.2%)出现针道感染。结论对于儿童GartlandⅡ型肱骨髁上骨折,保守治疗和手术治疗均可以获得良好的外观和临床功能。手术治疗可以获得更好的影像学结果,而保守治疗的并发症发生率更低。

Objective To compare the outcomes of conservative treatment versus surgery for Gartland typeⅡsupracondylar humeral fracture in children.Methods Retrospective review was conducted for clinical data of 41 children with Gartland typeⅡsupracondylar humeral fracture from January 2015 to December 2018.Their mean age was(5.4±2.2)years.According to therapeutic modality,they were divided into two groups of conservative treatment(A,n=17)and surgery(B,n=24).No significant inter-group differences existed in age,gender,sideness or follow-up time.During the final follow-up visit,the elbow angles were measured,including hyperextension angle,flexion angle,range of motion(ROM)and clinical carrying angle.And Baumann angle was measured on anterior-posterior(AP)radiograph.Additionally,anterior humeral line(AHL),bisecting the middle third of humeral capitellum on lateral radiograph,was also evaluated.Function of elbow joint was scored by the Quick Disabilities of Arm,Shoulder and Elbow(QuickDASH)and the Flynn grading criteria of elbow clinical function.Results During the final follow-up visit,hyperextension angle,flexion angle,ROM,clinical carrying angle and Baumann angle were(9.1±6.6)°,(139.2±6.7)°,(152±6.3)°,(8.4±5.9)°and(77.6±5.8)°respectively.No significant inter-group differences existed in these angles.For 11 children in group A(64.7%),the line of AHL passed through the middle third of capitellum(n=11,64.7%)and it was significantly less than that in group B(n=22,91.7%)(P=0.049).The total QuickDASH score was(1.5±2.1)and there was no inter-group difference.According to the Flynn criteria,the rate of excellent&good was 94.1%(16/17)in group A and 91.7%(22/24)in group B.There was no inter-group difference.In group A,one child(n=1,5.9%)developed cubitus varus.In group B,there were the complications of cubitus varus(n=1,4.2%),ulnar nerve injury(n=1,4.2%)and pin tract infection(n=1,4.2%).Conclusion Both conservative treatment and surgery can achieve excellent cosmetic and clinical outcomes in children with Gartland typeⅡsupracondylar humeral fractures.Surgery offers better radiographic outcomes while conservative treatment has a lower rate of complications.