闭合复位经皮克氏针固定与单纯石膏固定治疗儿童GartlandⅡB型和Ⅲ型肱骨髁上骨折疗效比较

Comparison of clinical effects between closed reduction percutaneous Kirschner wire fixation and plaster immobilization for treatment of Gartland typeⅡB and typeⅢpediaric supracondylar humeral fractures

目的比较闭合复位经皮克氏针固定与单纯石膏固定治疗儿童GartlandⅡB型和Ⅲ型肱骨髁上骨折的临床疗效。方法回顾性分析自2020-03—2021-06诊治的78例儿童GartlandⅡB型和Ⅲ型伸直型肱骨髁上骨折,其中38例骨折闭合复位后采用经皮克氏针固定(A组),40例骨折闭合复位后采用单纯石膏外固定(B组)。比较两组骨折复位固定时间、X线透视次数、治疗后3个月肘关节功能Flynn评分,以及骨折闭合复位即刻、治疗后3个月Baumann角。结果78例获得随访,随访时间平均5.5(3~12)个月。B组骨折复位固定时间较A组短,X线透视次数较A组少,差异有统计学意义(P<0.05)。A组1例出现针道感染,换药后痊愈。B组3例出现肘内翻畸形,二期行截骨矫形手术治疗。B组治疗后3个月Baumann角较骨折闭合复位即刻明显增大,差异有统计学意义(P<0.05)。A组治疗后3个月Baumann角小于B组,肘关节功能Flynn评分优于B组,差异有统计学意义(P<0.05)。结论与闭合复位单纯石膏外固定比较,闭合复位经皮克氏针内固定治疗儿童GartlandⅡB型和Ⅲ型肱骨髁上骨折的适应证更广,患儿肘关节功能恢复更满意,并发症更少。

Objective To compare the curative efficacy of closed reduction percutaneous Kirschner wire fixation and plaster immobilization for humeral supracondylar fractures of Gartland type Ⅱ B and type Ⅲ in children.Methods Seventy-eight children with Gartland type Ⅱ B and type Ⅲ humeral supracondylar fractures were treated from March 2020 to June 2021,including 38 cases of closed reduction and percutaneous Kirschner wire fixation(group A)and 40 cases of closed reduction and plaster immobilization(group B).The reduction and fixation time,the X-ray fluoroscopy frequency,the Flynn score of elbow joint function at 3 months after treatment,and the change of Baumann angle immediately after closed reduction of fracture and 3 months postoperatively were investigated in two groups.Results Seventy-eight cases were followed up,with an average followup time of 5.5 months(3-12 months).The fracture reduction and fixation time in group B was shorter than that in group A,and the X-ray fluoroscopy frequency was less than that in group A,with a statistically significant difference(P<0.05).One case in group A developed needle infection and healed after dressing change.In group B,3 cases developed cubitus varus deformity and underwent secondary supracondylar osteotomy and correction.After 3 months of treatment in Group B,the Baumann angle significantly increased compared to the immediate reduction of the closed fracture,with a statistically significant difference(P<0.05).After 3 months of treatment,the Baumann angle in group A was smaller than that in Group B,and the Flynn score of elbow joint function was better than that in group B,with a statistically significant difference(P<0.05).Conclusion Compared with closed reduction and plaster immobilization,closed reduction and percutaneous Kirschner wire internal fixation for children with Gartland type ⅡB and type Ⅲ condyle of humerus fractures has wider indications,more satisfactory recovery of elbow joint function and fewer complications.