克氏针不同固定方式治疗儿童Gartland Ⅲ型肱骨髁上骨折的疗效比较

目的：探讨儿童GartlandⅢ型肱骨髁上骨折治疗的最佳手术治疗方案。方法：搜集本院近3年内6～12岁Gart-landⅢ型肱骨髁上骨折患儿38例,随机分为A、B两组。其中A组行克氏针内外交叉内固定,共计20例;B组行外侧平行克氏针内固定,共计18例。定期随访,检查和记录一般感觉运动、末梢血运状况及肘关节功能,对2组术后功能优良率进行比较。结果：2组患儿均达到解剖复位,术后接受12～18个月（平均16个月）的随访,根据Flynn标准评定,2组关节功能优良率分别为90%和94.4%,差异无统计学意义（P〉0.05）。2组共4例出现肘内翻畸形,组间无统计学差异,（交叉固定组）出现1例尺神经损伤,外侧固定组未见。结论：针对儿童GartlandⅢ型肱骨髁上骨折,2种克氏针固定方式效果相似,均能达到满意的临床效果。但是外侧平行固定可避免医源性尺神经损伤。

Efficacy Comparison of the Gartland Type III Supracondylar Fracture of Humerus Fixated with Kirschner Wire in Children

Objective: To explore the best surgical treatment to the Gartland type III supracondylar fracture of humerus in children.Methods:38 patients(range,6 to 12 years old) with Gartland type III supracondylar fracture of humerus were collected from January,2008 to Jaunary,2011.They were divided into 2 groups.20 cases in group one were cross-fixated by inside and outside with Kirschner wire;18 cases in group two were fixated in parallels by lateral with Kirschner wire.Sensation,movement,peripheral revascularization status and function of the elbow were evaluated and compared between the two groups.Results:The average follow-up was 16 months(range,from 12 to 18 months).All patients were obtained anatomical reduction.The excellent-good rate in elbow function is 90% and 94.4%,respectively,with no statistically significance(P>0.05).The ulnar nerve injury occurred in one patient in the group one.The deformity of cubitus varus occurred in four cases for all the patients.Conclusions: The clinical effect of Gartland type III supracondylar fracture of humerus in children fixated with Kirschner wire by the two ways were similar.But,iatrogenic ulnar nerve injury could be avoided by lateral parallel Kirschner wire fixation technique.