闭合复位石膏托固定加石膏外牵引治疗儿童肱骨髁上骨折的病例对照研究

目的：比较闭合复位石膏托固定加石膏外牵引疗法与手术治疗无神经血管合并症的儿童闭合性Gart-landⅢ型肱骨髁上骨折的临床疗效。方法：自2009年6月至2012年6月，对151例儿童无神经血管损伤合并症的闭合性肱骨髁上骨折的临床资料进行回顾性分析，骨折均为GantlandⅢ型，其中男87例，女64例；年龄1～12岁，平均5．3岁。采用闭合复位石膏托外固定治疗76例（保守组），手术切开复位克氏针内固定75例（手术组）。记录并对比分析两组的骨折愈合时间、肘关节功能锻炼时间、肘关节功能恢复情况；采用Flynn肘关节功能评分标准对临床疗效进行评定。结果：151例患儿均获随访，平均18.3个月（6～36个月）。保守组的骨折愈合时间及功能锻炼时间明显短于手术组（P〈0．001）。两组肘关节屈伸活动度丢失量及提携角比较差异无统计学意义（P〉0．05）。采用Flynn等评定标准对临床疗效进行评估：保守组优31例，良35例，可7例，差3例；手术组优27例，良30例，可17例，差1例；两组疗效比较差异无统计学意义（P〉0．05）。结论：闭合复位石膏托固定加石膏外牵引治疗无神经血管损伤合并症的儿童闭合性Gart-landⅢ型肱骨髁上骨折，疗效与手术治疗相当，骨折愈合时间短，便于早期锻炼肘关节，是一种较为理想的治疗选择。

Case-control study on close reduction and plaster slab fixation combined with plaster external traction for the treat- ment of pediatric Gartland type HI supracondylar humerus fractures

To compare the therapeutic effects between close reduction and plaster slab fixation combined with plaster external traction and operation for the treatment of pediatric closed Gartland type Ⅲ supracondylar humerus fractures without neurovascular injury complications. Methods：From June 2009 to June 2012,151 children with closed Gartland Ⅲ supracondylar humerus fractures were retrospectively studied and divided into two groups,including 87 boys and 64 girls, ranging in age from 1 to 12 years old with an average of 5.3 years old. Among them,76 children （conservative group） were treated with close reduction and plaster slab fixation combined with plaster external traction ;75 children （operation group） un- derwent surgical operation. The time of elbow joint function exercise, the healing time of fracture, the function recovery of elbow joint and carrying angle was recorded and analyzed. The therapeutic effects were evaluated by the Flynn criteria system. Re-suits： All patients were followed up from 6 to 36 months （ 18.3 months on average）. The average time of fracture healing and el- bow joint functional exercise of the conservative group was shorter than those of operation group （P〈0.001）. Motion range of the elbows and carrying angle of two groups were no statistical difference （P〉0.05）. According to Flynn criteria system, in conser- vative group, the result was excellent in 31 cases, good in 35, fair in 7, and poor in 3 ; in operation group, 27 in excellent, 30 in good, 17 in fair and 1 in poor; there was no significant difference between two groups in therapeutic effects （P〉0.05）. Conclu-sion ： Close reduction and plaster slab fixation combined with plaster external traction in treatment of pediatric closed Gartland type m supracondylar humerus fractures without neurovascular injury complications,which has similar effect to surgical treat- ment, and the time of fracture healing and elbow joint function exercise are significantly shorter.