2种方法治疗 GartlandⅢ型儿童髁上骨折的早期疗效观察

摘要

目的：比较闭合复位术和有限切开内固定术治疗GartlandⅢ型儿童髁上骨折的早期疗效及探讨治疗方法选择。方法回顾分析自2010年5月至2014年5月在我院受闭合复位术（Ⅰ组）或有限切开内固定术（Ⅱ组）治疗的GartlandⅢ型儿童髁上骨折患者32例的相关资料。比较两组患者的手术时间、住院时间、术后并发症情况及评估末次随访时肘关节功能情况。结果所有患者均随访3月。①按Mayo肘关节评分标准，Ⅱ组优良率为88．88％，高于Ⅰ组优良率64．29％，但两组差异无统计学意义。②Ⅰ组手术时间为（59．57±5．76）min，Ⅱ组为（47．94±8．61）min，差异有统计学意义（t＝4．3390，P＝0．001）；Ⅰ组住院时间为（6．34±1．00）d，Ⅱ组为（11．44±2．00）d，差异有统计学意义（t＝8．1670，P＝0．0000）；③Ⅰ组一过性神经损伤6例，肘内翻畸形3例；Ⅱ组一过性神经损伤2例，针道感染2例，均无统计学差异。结论有限切开复位克氏针内固定术是治疗GartlandⅢ型儿童髁上骨折的有效方法，具有手术简单、创伤小、复位快、克氏针固定准确等特点。%Objective To compare the early curative effects of closed reduction and limited open reduction for the treatment of Gartland Ⅲtype supracondylar fracture in children and discuss the therapy option . Methods From May 2011 to May 2014, the datas of 32 cases of Gartland Ⅲtype humeral supracondylar fracture which were managed with closed reduction ( group I,14cases) or limited open reduction and internal fixation (group II,18cases) were retrospectively analyzed.Operation time, hospitalization time and postoperative complication of the two groups were compared and elbow function at the time of the latest follow -up was evaluated.Results All patients were followed up for 3 months.According to the Mayo elbow score standard , the excellent and good rate of group II (88.88%) was higher than group I (64.29%),but there was no significant difference between the two groups .Operation time of group I was 59.57 ±5.76min, while it was 47.94 ±8. 61min of group Ⅱ, the difference between the two groups was statistically significant (t=4.3390, P=0.001). Hospitalization time of group I was 6.34 ±1.00d, while it was 11.44 ±2.00d of groupⅡ, the difference between the two groups was statistically significant (t =8.1670,P =0.0000) There were 6 cases of temporary nerve injury, 3 cases of cubitus varus deformity in group I .And 2 cases of temporary nerve injury , 2 cases of superficial pin tract infection in group Ⅱ.Conclusions Limited open reduction and internal fixation with K -wires is feasible for the treatment of pediatric Gartland Ⅲ type supracondylar fracture , and it has the following characteristics including relatively simple operation , minimal trauma, quick reset and kirschner wire fixation exactly.