三根克氏针不同固定方式治疗儿童肱骨髁上骨折的病例对照研究

目的：通过对三根克氏针不同固定方式治疗肱骨髁上骨折疗效的比较,寻找最佳的固定方式。方法：2008年7月至2009年5月采用闭合复位经皮克氏针3种不同固定方法治疗60例肱骨髁上骨折。方法1：通过冠突窝桡侧缘固定,共20例,男11例,女9例;年龄2～13岁,平均（5.4±0.5）岁;均为闭合新鲜骨折,均无神经及血管损伤;Gartland Ⅱ型13例,Gartland Ⅲ型7例。方法2：通过冠突窝尺侧缘固定,共20例,男13例,女7例;年龄2～11岁,平均（6.1±0.4）岁;均为闭合新鲜骨折;Gartland Ⅱ型11例,Gartland Ⅲ型9例;术前有尺神经损伤2例,均无血管损伤。方法3：通过冠突窝中间固定,共20例,男8例,女12例;年龄3～14岁,平均（7.4±0.6）岁;均为闭合新鲜骨折,桡神经损伤2例,均无血管损伤;Gartland Ⅱ型7例,Gartland Ⅲ型13例。术后1年时,在X线片测量Carrying角及Baumann角,并观测此时的肘关节伸屈情况。按Flynn临床功能评定标准对患肘关节功能进行评价,比较3种方法的疗效。结果：肘关节伸屈功能丢失情况：方法1为（14.04±3.25）°,方法2为（13.14±2.34）°,方法3为（9.25±2.56）°。Carrying角改变值：方法1为（7.64±1.78）°,方法2为（7.38±1.68）°,方法3为（5.27±1.13）°。Baumann角改变值：方法1为（28.55±3.23）°,方法2为（27.55±2.23）°,方法3为（21.45±1.73）°。Flynn临床功能评定结果：方法1优11例,良4例,差5例;方法2优12例,良3例,差5例;方法3优11例,良6例,差3例。方法3固定治疗效果优于其他两种方法。结论：克氏针不同固定方式治疗肱骨髁上骨折的疗效也不同,通过冠突窝中间的治疗方法优于其他方法。

Case-control study on therapeutic effects of different fixation methods with three Kirschners wires for the treatment of humeral supracondylar fractures

Objective：To compare therapeutic effects of three fixation methods with three Kirschner wires,and to find the best fixation method.Methods：From July 2008 to May 2009,60 patients with humeral supracondylar fractures were treated.Among patients in Group A,11 patients were male and 9 patients were female,ranging from 2 to 13 years old,with an average of（5.4±0.5）years;all the patients in Group A were fresh closed fractures without nerve and blood vessel injuries,13 patients were type Ⅱ and 7 patients were type Ⅲ according to Gartland classification;and all the patients in Group A were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through radial edge of coronoid fossa.Among patients in Group B,13 patients were male and 7 patients were female,ranging from 2 to 11 years old,with an average of（6.1±0.4）years;all the patients in Group B were fresh closed fractures without blood vessel injuries,11 patients were type Ⅱ and 9 patients were type Ⅲ according to Gartland classification,2 patients had ulnar nerve injuries before treatment;and all the patients in Group B were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through ulnar edge of coronoid fossa.Among patients in Group C,8 patients were male and 12 patients were female,ranging from 3 to 14 years old,with an average of（7.4±0.6）years;all the patients in Group C were closed fresh fractures without blood vessel injuries,7 patients were type Ⅱ and 13 patients were type Ⅲ according to Gartland classification,2 patients had radial nerve injuries before treatment;and all the patients in Group C were treated by three Kirschner wires fixation with the third Kirschner different wire fixed through middle of coronoid fossa.After 1 year of treatment,the Carrying and Baumann angles were measured on the X-ray of all patients in the three groups,and the motion range of elbow joint was observed.The Flynn evaluation criteria were used to compare therapeutic effects among the three groups.Results：All the patients were followed up.The function loss of elbow joint were（14.04±3.25）°in Group A,（13.14±2.34）° in Group B,and（9.25±2.56）° in Group C.Changes of Carrying angle were（7.64±1.78）° in Group A;（7.38±1.68）° in Group B,and（5.27±1.13）° in Group C.Changes of Baumann angle were（28.55±3.23）° in Group A,（27.55±2.23）° in Group B,（21.45±1.73）° in Group C.According to Flynn criteria,there were 11 patients got excellent result,4 good and 5 poor in Group A;in Group B,12 patients got excellent result,3 good and 5 poor;in Group C,11 patients got excellent result,6 good and 3 poor.The therapeutic effects of Group C was better than those of Group A and Group B.Conclusion：There are different effects among three kinds of operative approaches for the humerus supracondylar fractures.The fixation method with one Kirschner wire through middle part of coronoid fossa is better than the other two fixation methods.