三种固定方法治疗儿童肱骨髁上骨折的临床对照试验

目的:探讨不同固定方法治疗儿童移位肱骨髁上骨折临床疗效及其临床适应证。方法:137例儿童移位肱骨髁上骨折患者,男85例,女52例;年龄3~12岁。分别采用交叉克氏针内固定(A组)38例,小夹板外固定(B组)67例,石膏托外固定(C组)32例。观察3组骨折愈合时间、肘内翻的发生率及肘关节伸屈功能并进行比较。结果:本组随访6个月~5年,平均29个月,参照Flynn疗效评价标准:A组,优29例,良7例,差2例,优良率为94.74%;B组,优12例,良49例,差6例,优良率为91.04%;C组,优9例,良16例,差7例,优良率为78.13%。A组疗效分别与B、C组比较,差异有统计学意义(P<0.05);B组与C组疗效比较,差异无统计学意义(P>0.05)。结论:三种固定方法以闭合克氏针固定疗效最佳,但三种固定方法各有其适应证:对无移位或轻度移位的肱骨髁上骨折可采用石膏托固定或小夹板固定;对严重移位或旋转,极不稳定型骨折可采用闭合交叉克氏针穿针固定或小夹板固定。临床应根据骨折类型、皮肤条件以及是否合并有神经血管损伤来合理选择最佳治疗方案。

A controlled clinical trial on three methods for the treatment of displaced humeral supracondylar fractures in children

Objective:To investigate therapeutic effects and indications of three different methods for the treatment of displaced humeral supracondylar fractures in children.Methods:One hundred and thirty-seven children(85 males and 52 females,ranging in age from 3 to 12 years) with displaced humeral supracondylar fractures were treated with three methods,including patients in Group A treated with closed reduction and percutaneous crossed-pin fixation,patients in Group B treated with manual reduction and immobilization in splints,and patients in Group C treated with manual reduction and immobilization in plaster cast.The healing time of fractures,incidence rates of cubitus varus,as well as extension and flexion functions of elbow joint of patients in three groups were analyzed and therapeutic effects of three groups were compared.Results:All the patients were followed-up,and the duration of follow-up ranged from 6 months to 5 years,with an average of 29 months.According to Flynn criteria,in Group A,29 patients got excellent results,7 good,2 fair,the excellent and good rate was 94.74%;in Group B,above data were 12,49,6 and 91.04%;while in Group C,the data were 9,16,7 and 78.13% respectively.The result of statistical analysis demonstrated that the difference of therapeutic effects between Group A and Group B was significant(P<0.05) and that the difference between Group A and Group C was also significant(P<0.05),but the difference between Group B and Group C was not significant(P>0.05).Conclusion:Stable fractures which have no displacement or little displacement can be treated with manual reduction and immobilization in splints or plaster cast.Percutaneous crossed-pin or splint fixation is preferred for the treatment of those unstable fractures.The key point of the treatment is rational selection of three different ways for the treatment of displaced humeral supracondylar fractures in children according to the type of fractures and damages of skin and tissue and whether complications with nerve and vascular damages.