正骨十四法联合小夹板外固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折临床疗效观察

Observation on Clinical Efficacy of Fourteen Bone-Setting Manipulations Combined with Small Splint External Fixation for the Treatment of Gartland TypeⅡandⅢSupracondylar Fracture of Humerus in Children

【目的】探讨正骨十四法联合小夹板外固定治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折的临床疗效。【方法】回顾性分析2016年1月至2022年6月佛山市中医院骨科收治的58例GartlandⅡ、Ⅲ型肱骨髁上骨折患儿临床资料,按治疗方法的不同分为保守组(正骨十四法联合小夹板外固定)28例和手术组(闭合复位克氏针内固定)30例,观察2组患儿的骨折愈合时间、Baumann角、提携角、肘关节活动度、前臂旋转活动度以及并发症发生情况,并运用Flynn肘关节功能评分评价2组患儿的临床疗效。【结果】(1)治疗后,保守组的优良率为92.9%(26/28),手术组为90.0%(27/30),2组患儿的临床疗效比较(秩和检验),差异无统计学意义(P>0.05)。(2)2组患儿的骨折愈合时间及前臂旋前、前臂旋后、肘伸、肘屈活动度比较,差异均无统计学意义(P>0.05)。(3)手术组患儿的Baumann角略小于保守组,提携角略大于保守组,组间比较,差异均有统计学意义(P<0.05)。(4)在并发症方面,保守组的并发症发生率为7.1%(2/28),明显低于手术组的30.0%(9/30),差异有统计学意义(P<0.05)。【结论】两种治疗方式治疗儿童GartlandⅡ、Ⅲ型肱骨髁上骨折均可获得满意疗效和肘关节功能恢复,闭合复位克氏针内固定骨折复位更好,而正骨十四法联合小夹板外固定治疗损伤更少,并发症发生率更低。

Objective To investigate the clinical efficacy of fourteen bone-setting manipulations combined with small splint external fixation for the treatment of Gartland typeⅡandⅢsupracondylar fracture of humerus in children.Methods The clinical data of 58 children with Gartland typeⅡandⅢsupracondylar humerus fractures admitted to the Department of Orthopedics of Foshan Hospital of Traditional Chinese Medicine from January 2016to June 2022 were retrospectively analyzed.The 28 children treated by fourteen bone-setting manipulations combined with small splint external fixation were allocated to the conservative group,and the 30 children treated by closed reduction and internal fixation with Kirschner wires were allocated to the surgical group.The two groups were observed in terms of the fracture healing time,Baumann angle,carrying angle,elbow range of motion(ROM),forearm rotation ROM and the incidence of complications.After treatment,the clinical efficacy of the two groups was evaluated with the Flynn scores of elbow function.Results(1)After treatment,the excellent rate in the conservative group was 92.9%(26/28)and that in the surgical group was 90.0%(27/30).The difference of clinical efficacy(tested by rank sum test)between the two groups was not statistically significant(P<0.05).(2)There was no statistically significant difference in the healing time of fracture and the ROM of forearm pronation and supination,and elbow extension and flexion between the two groups(P>0.05).(3)The Baumann angle in the surgical group was slightly smaller than that in the conservative group,and the carrying angle was slightly larger than that in the conservative group,and the differences between the two groups were statistically significant(P<0.05).(4)The incidence of the complications in the conservative group was 7.1%(2/28),which was significantly lower than that in the surgical group[30.0%(9/30)],and the difference was statistically significant(P<0.05).Conclusion The two treatment methods for GartlandⅡandⅢsupracondylar fracture of humerus in children all result in satisfactory clinical efficacy and fine functional recovery of the elbow joint.The fractures are well repositioned by closed reduction and internal fixation with Kirschner wire,and the therapy of fourteen bone-setting manipulations combined with external fixation with a small splint results in less injury and fewer complications.