两种闭合复位固定方法治疗儿童肱骨髁上骨折的疗效比较

Effect comparison of two closed reduction and fixation methods for humeral supracondylar fracture in children

目的比较两种闭合复位固定方法治疗儿童肱骨髁上骨折的疗效。方法将60例伸直型肱骨髁上骨折患儿按照治疗方法不同分为观察组(采用克氏针辅助复位配合旋后位石膏固定,30例)和对照组(采用克氏针穿针固定配合中立位石膏固定,30例)。比较两组骨折复位质量(Baumann角及侧位肱头角)、骨折复位丢失情况、骨折愈合时间、肘关节活动度、前臂旋转度、并发症发生情况。采用Mayo评分评价肘关节功能恢复情况。结果患儿均获得随访,时间8~16周。两组治疗后X线片均显示骨折对位对线良好,已达解剖或功能复位,无成角、短缩、旋转畸形;Baumann角均正常,且观察组小于对照组(P<0.01),侧位肱头角两组比较差异无统计学意义(P>0.05)。两组治疗后1周及拆除石膏后均未见复位丢失,均未发生肘内翻、外翻等并发症。两组骨折均愈合,时间3~4周。治疗后6、8周Mayo评分评价的肘关节功能优良率及治疗后8周的肘关节活动度、前臂旋转度:两组比较差异均无统计学意义(P>0.05)。结论与克氏针穿针固定配合中立位石膏固定相比,克氏针辅助复位配合旋后位石膏固定治疗儿童肱骨髁上骨折不仅降低了复位操作难度,避免了手术取出克氏针可能产生的风险,而且复位效果肯定,患儿肘关节功能恢复满意,安全性较高。

Objective To compare the efficacy of two closed reduction and fixation methods in the treatment of humeral supracondylar fracture in children.Methods Sixty children with extended humeral supracondylar fractures were divided into observation group(using Kirschner wire-assisted reduction combined with supination plaster fixation,30 cases)and control group(using Kirschner wire threading needle fixation combined with neutral plaster immobilization,30 cases).The quality of fracture reduction(Baumann angle and lateral humerocephalic angle),the loss of fracture reduction,fracture healing time,the range of motion of the elbow joint,the rotation range of the forearm and the incidence of complications were compared between the two groups.The recovery of elbow joint function was evaluated by Mayo score.Results All patients were followed up for 8~16 weeks.After treatment,X-ray films of both groups showed that fractures were well aligned and had achieved anatomical or functional reduction,without angulation,shortening or rotational deformity;Baumann angles were normal,and the observation group was smaller than the control group(P<0.01).There was no significant difference in lateral brachiocephalic angle between the two groups(P>0.05).After 1 week of treatment and removing the plaster cast,there was no loss of reduction;and no complications such as cubitus varus and valgus occurred in the two groups.All fractures of two groups healed within 3~4 weeks.Two groups had no statistical differences between the two groups in the following data,including the excellent-good rate of functional recovery of elbow joint evaluated by Mayo score at 6,8 weeks after treatment,and the elbow joint movement and forearm rotation range at 8 weeks after treatment(P>0.05).Conclusions Compared with Kirschner wire threading needle fixation combined with neutral cast fixation,Kirschner wire-assisted reduction combined with supination cast fixaiton in the treatment of children with humeral supracondylar fracture not only reduces the operative difficulty of reduction,but also avoids the possible related risk of surgical removal of the Kirschner wire.The reduction effect is positive,and the recovery of elbow joint function in the children are satisfactory,with high safety.