手法按摩配合支具固定纠正鲍曼角异常95例

95 Cases of Clinical Study for Manual Massage Combined with Brace Fixation on the Treatment of Patients with Abnormal Baumann's Angle

目的:探讨手法按摩配合支具固定纠正肱骨髁上骨折鲍曼角(Baumann's Angle)异常的安全性及临床疗效。方法:2015年1月至2023年12月,采用手法按摩配合支具固定纠正肱骨髁上骨折鲍曼角异常的患者95例。其中男50例,女45例;年龄为1~12岁,中位数为5.6岁;均为肱骨髁上骨折患者。致伤原因:平地跌倒81例,高处坠落12例,交通伤2例。按Gartland分型:Ⅱ型43例,Ⅲ型52例。本组患者中合并桡神经损伤5例,合并尺神经损伤1例,合并正中神经损伤3例;非手术治疗患者78例,手术治疗患者17例。X线片均明确诊断为肱骨髁上骨折;受伤至就诊时间为1h~3d,中位数为1.5d;病程为3~6个月,中位数为3.5个月。对于治疗后期存在鲍曼角异常的患者,会根据情况去除外固定或内固定,然后使用外翻矫形支具固定,同时进行外翻手法按摩及肘关节屈伸功能锻炼。分别在治疗后1个月、3个月、6个月、12个月摄X线片测量鲍曼角,同时记录患肢肘关节屈伸功能及外观情况。以鲍曼角的测量值对外观情况进行评价,以Flynn临床功能评定标准对患肢肘关节功能进行评价。结果:95例患者获随访,随访时间为3个月~3年,中位数为1年。所有合并神经损伤的患者均恢复正常,根据Flynn临床功能评定标准,93例患者肘关节屈伸功能恢复优,2例患者肘关节功能恢复良。95例患者佩戴支具治疗后鲍曼角均较佩戴支具前减小,其中65例患者鲍曼角最终完全恢复正常,患肢外观无异常;23例患者鲍曼角稍增大,患肢外观内翻在5°以内或呈直肘;7例患者鲍曼角明显异常,患肢呈肘内翻畸形;优良率为92.6%。治疗期间未发生其他不良反应。结论:对于肱骨髁上骨折治疗后存在鲍曼角异常的患者,在塑形阶段采用手法按摩配合外翻矫形支具固定患肢于旋后外翻位,改善鲍曼角有效,从而达到预防肘内翻畸形发生的目的,采用本方法无创、简单,未见明显不良反应,是治疗此类疾病的较好方法,值得临床推广应用。

Objective:To explore the safety and clinical efficacy of manual massage combined with brace fixation in correcting abnormal Baumann's angle in humeral supracondylar fractures.Methods:From January 2015to December 2023,95patients with abnormal Baumann's angle of supracondylar humeral fracture were corrected by manual massage combined with brace fixation.The aged from 1to 12years old with 5.6years old on average.All patients were supracondylar fractures of the humerus.The causes of injury included flat falls in 81cases,falling from height in 12cases,and traffic accidents in 2 cases.According to Gartland classification,there were 43cases of typeⅡand 52cases of typeⅢ.There were 5cases of radial nerve injury,1case of ulnar nerve injury,and 3cases of median nerve injury.There were 78cases of non-surgical treatment and 17cases of surgical treatment.X-ray films are clear on the diagnosis of humerus condyle fracture.The interval between injury and admission ranged from 1hto 3d(median,1.5d).Course of 36months and a median of 3.5 months.For treating patients with Baumann's angle abnormalities in the late we will except to fixed or internal fixation according to the circumstance,and then use fixed with a valgus orthopaedic,simultaneously eversion massage and function exercise elbow flexion and extension.Respectively after treatment 1month,3months,6months,12months Baumann's angle measured X-ray films at the same time,record the limb function and appearance of elbow flexion and extension.Baumann's angle was used to evaluate the appearance,and Flynn clinical function evaluation criteria was used to evaluate the elbow joint function.Results:95patients received follow-up,followed up for 3months to 3years,the median 1year.All merge nerve injury patients return to normal,according to the clinical functional assessment standards,Flynn elbow flexion and functional recovery in 93patients,2cases of patients with elbow joint function was good.After 95patients treated with a wear Baumann's angle are also worn with a former decreases,and among them,65cases of patients with Baumann's angle finally completely back to normal,limb appearance without exception,23cases with Baumann's angle increases slightly,limb in appearance or within 5°elbow straight,7cases with Baumann's angle apparently unusual,limb elbow varus deformity.No other adverse reactions occurred during the treatment,and the excellent and good rate was 92.6%.Conclusion:For patients with abnormal Baumann's angle after treatment of humeral supracondylar fracture,we use technique in shaping stage massage valgus orthopaedic fixed with a limb valgus position after the rotation,can effectively improve Baumann's angle,so as to achieve the aim of preventing elbow varus deformity happened to adopt this approach is simple,noninvasive,no obvious adverse reaction,it is a good method to treat such patients and worthy of clinical promotion.