屈肘旋前位石膏外固定在儿童Ⅱ型肱骨髁上骨折的作用

摘要

ObjectiveTo compared the efficacy of plaster fixation with the elbow in a position of flexion and pronation with a position of neutral in Gartland II children’s humerus fractures on the basis of the successful manipulation.Methods The 72 patients with Gartland type II humerus fractures were colected and divided into two groups. The treatment group fixed the elbows in a position of flexion and pronation while the control group fixed in flexed and neutral position. B-angle were measured in three different times when post-reduction,two weeks after fixation and removing the plaster. The rates of varus malunion were compared and Flynn elbow function scores were performed at the time of the latest folow-up.ResultsThe rates of varus malunion in treatment group was 8.33% while 16.67% in control group. There was not significant difference between two groups(P>0.05).There was significant difference between two groups at each period when the plasters performed or removed (P<0.05). The excelent rate of Flynn elbow function scores was 94.4% in treatment group at the end of the folow-up,while the control group was 77.8%. There was significant difference between two groups,(χ2=6.95 ,P<0.05).Conclusion Fixation with the elbow in a position of flexion and pronation could effectively decreased Baumann angle and improve the Flynn elbow function scores.%目的：在手法整复成功基础上，对比屈肘旋前位与中立位两种固定方法的临床疗效。方法选取GartlandⅡ型的肱骨髁上伸直型骨折72例，分为两组，分别采用屈肘旋前位及中立位固定。在复位后、固定2周后及解除外固定3个不同时间点测量Baumann角，对比两组的肘内翻发生率，末次随访进行Flynn关节功能评分。结果治疗组最后出现肘内翻的有3例，发生率为8.33%；对照组最后出现肘内翻的有6例，发生率为16.67%；发生率比较差异无统计学意义（P＞0.05）。在随访期间及解除固定两个时间段，两组B角组间进行对比，差异有统计学意义（P＜0.05）。治疗组末次随访Flynn评分疗效优良率为94.4%，而对照组Flynn评分疗效优良率为77.8%，两组的疗效对比，（χ2=6.95，P＜0.05），差异有统计学意义。结论屈肘旋前位石膏固定治疗肱骨髁上伸直型骨折可有效减少Baumann角的增大，提高肘关节Flynn评分。