移位型肱骨髁上骨折的疗效及相关影响因素的回顾性研究

目的 探讨移位型肱骨髁上骨折的临床疗效及其影响因素.方法 采用回顾性队列研究设计方法.根据不同治疗方式,将240例肱骨髁上骨折病例平均分为手法整复外固定组、牵引加手法整复外固定组、手术切开复位内固定组、闭合复位穿针内固定组共4组.结果 4组一般情况比较,差异均无统计学意义（P＞0.05）;携带角差值、前倾角差值比较,差异均无统计学意义（P＞0.05）;术后并发症比较,差异有统计学意义（P＜0.05）,其中手法整复外固定组与手术切开复位内固定组、闭合复位穿针内固定比较,差异均有统计学意义（P＜0.05）;JOA肘关节功能评价比较,差异均无统计学意义（P＞0.05）.结论 闭合手法整复小夹板外固定医源性损伤小,后遗症少.如肿胀严重或手法复位失败者,可行牵引治疗,待肿胀消退后,再改用夹板外固定,或行闭合复位穿针内固定术.对骨折端有软组织嵌顿,无法闭合复位者,特别是严重移位的不稳定型骨折或肱动脉损伤者,则应在适当时机行切开复位克氏针内固定术.

Retrospective Study of Clinical Efficacy and Related Factors of Displaced Supracondylar Fracture

Objective To explore the clinical efficacy and related factors of displaced supracondylar fracture. Methods The retrospective cohort study design method was adopted. According to different treatment, 240 cases of supracondylar fracture were divided into 4 groups, including the manipulation external fixation group, traction and manipulation external fixation group, surgical open reduction and internal fixation group, and closed reduction and pin fixation group. Results There was no statistically significant difference in general conditions among 4 groups （ P 〈0. 05）. There were no statistically significant differences in carrying angle difference and anteversion difference （ P 〈0.05）. There was statisti- cally significant difference in postoperative complications （ P 〈0.05）, especially between manipulation external fixation group and surgical open reduction and internal fixation group （ P 〈0. 05）, and between manipulation external fixation group and closed reduction and pin fixation group （ P 〈0. 05）. There was no statistically significant difference in JOA elbow functionality evaluation（ P 〈0.05）. Conclusion Closed manipulation and splint external fixation have little Iatrogenic injury and small sequela. Such as severe swelling or the manual reduction loser, feasible traction therapy should be used. Until the swelling subsided, just switch to external fixation or the needle closed reduction and internal fixation. For frac ture soft tissue incarcerated, unable to closed reduction, especially severely displaced unstable fractures or injuries of the brachial artery, open re duction and Kirschner wire fixation should be adopted at the appropriate time.