不同外固定方法治疗肱骨髁上骨折临床疗效比较

目的：比较不同外固定方法治疗儿童移位性肱骨髁上骨折的临床疗效和肘内翻发生率：方法：226例移位性儿童肱骨髁上骨折患者，男134例，女92例；年龄5～12岁，平均8．58岁：手法复位后分别采用小夹板和塑形托板双重外固定治疗（A组）88例（男51例，女37例；年龄5．1～12岁），小夹板外固定治疗（B组）74例（男44例，女30例；年龄5～11．8岁），以及石膏托外固定治疗（C组）64例（男39例，女25例；年龄5．5～12岁）。观测3组骨折临床愈合时间、肘关节功能、肘内翻等指标，比较临床综合疗效及肘内翻发生率。结果：随访6个月～4年，平均25个月，参照疗效评定标准：A组优59例，良23例，差6例，优良率为93．18％；B组优37例，良29例，差8例，优良率为89．19％；C组优20例，良31例，差13例，优良率为79．69％：A、B、C三组肘内翻发生率分别为6．82％、17．57％、32．81％。A组临床疗效和肘内翻发生率分别与B、C组比较，差异均有统计学意义（P〈O．05）；B组与C组比较，差异亦有统计学意义临床疗效：A组优于B、C组，B组优于C组。肘内翻发生率：A组低于B、C组，B组低于C组。结论：三种外固定方法以小夹板和塑形托板双重外固定疗效最佳，此种外固定方法稳定性高、抗旋转作用强、可调性好、关节功能恢复快、肘内翻发生率低、临床疗效佳，小夹板和塑形托板双重外固定应作为治疗儿童肱骨髁上骨折的首选外固定方法.

Comparison of clinical effects of various external fixation for the treatment of humeral supracondylar fracture

Objective: To compare clinical effects and the incidence rates of cubitus varus in displaced humeral supracondylar fractures treated with different kinds of external fixation. Methods: Among 226 children with displaced humeral supracondylar fractures,134 patients were male and 92 patients were female, ranging in age from 5 to 12 years,with an average of 8.58 years. After manipulative reduction,the patients were treated with three kinds of external fixation:the 88 patients(51 males and 37 females,ranging in age from 5.1 to 12 years) in Group A were treated with double external fixations of small splint and moulding splint;74 patients(44 males and 30 females,ranging in age from 5 to 11.8 years) in Group B were treated with small splint;and 64 patients(39 males and 25 females,ranging in age from 5.5 to 12 years) in Group C were treated with plaster slab. The indexes such as healing time of fractures,the functions of elbow joint and cubitus varus were observed. The clinical effects and the incidence rates of cubitus varus in three groups were compared. Results: All the patients were followed-up,and the duration of follow-up ranged from 6 months to 4 years,with an average of 25 months. According to the standard for efficacy evaluation,in Group A,59 patients got an excellent result,23 good,6 bad,the excellent and good rate was 93.18%;in Group B,above data were 37,29,8,89.19% respectively;while in Group C,the data were 20,31,13 and 79.69% respectively. The incidence rates of cubitus varus of three groups were 6.82%,17.57% and 32.81% respectively. The result of statistical analysis demonstrated that there were significant differences of the clinical effects and the incidence rates of cubitus varus in three groups (P<0.05). Comparison of the clinical effects:Group A was better than Group B and Group C,Group B was better than Group C. The incidence rates of cubitus varus:Group A was lower than Group B and Group C,Group B was lower than Group C. Conclusion: The therapeutic effects of double external fixation is the best among three groups. The double external fixation had follow advantages:external fixation,high stability,strong anti-rotation ability,and joint function quick recovery,the incidence rates of cubitus varus lower and good clinical effects. So double external fixation method should be the first choose for the treatment of humeral supracondylar fractures.