两种手术入路治疗复杂小儿肱骨髁上骨折疗效的比较  

Comparison of trealment outcomes between two surgical approaches for treating pediatric displaced supracondylar humeral fractures

作　　者：陈情忠[1] 龚炎培[1] 顾剑辉[1] 

机构地区：[1]南通大学附属医院手外科,江苏南通226001

出　　处：《中华手外科杂志》2014年第2期124-126,共3页Chinese Journal of Hand Surgery

摘　　要：目的比较两种手术入路对复杂的小儿肱骨髁上骨折疗效的影响。方法随访2010年7月至2011年12月采用肘后人路切开复位克氏针内固定治疗的34例复杂的肱骨髁上骨折患儿。随访时间16～32个月，平均（21．7±4．4）个月。按照肱三头肌不同的处理方法，将病例分为肱三头肌正中切开入路组（A组），肱三头肌旁人路组（B组）。A组19例，B组15例。随访内容：两侧肘关节活动度（屈曲、背伸），前臂旋前、旋后活动范围；提携角，两侧伸肘肌力；影像学资料（Bamnann角、肱骨干髁角）；Mayo肘关节功能评分。记录随访结果，并对最后一次随访结果进行统计学分析。结果两组病例中肘关节活动度及前臂旋前、旋后活动范围均在正常范围，两组间差异无统计学意义。计算患侧伸肘肌力与健侧的百分比，两组问差异无统计学意义。Mayo肘关节功能评分均为100分，两组间差异无统计学意义。测量Baumann角、肱骨干髁角，两组的均值均在正常范围内，两组间的差异无统计学意义。结论肱三头肌旁及肱三头肌正中切开两种入路在小儿肱骨髁上骨折治疗中具有相同的疗效。Objective To compare the results between two surgical approaches for treating complex supracondylar humeral fractures in children. Methods Open reduction and internal fixation with Kirschner wires were carried out through a posterior incision around the elbow to treat 34 cases of podiatric displaced supracondylar humeral fractures from July 2010 to December 2011. These cases were divided into two groups based on the way with which the triceps brachii was managed. In group A （triceps - splitting approach） the triceps was split in the midline to allow access, while in group B （paratricipital approach） access was gained via a lateral triceps approach. The patients were follow-up postoperatively for 16 to 32 months, with an average of 21.7 months. Objective and subjective functional results （elbow range of motion including flexion/extension and pronation/supination, the strength of triceps muscle, carrying angle, Mayo Elbow Performance Score） and radiographic data （Baumann angle, humerocapitellar angle） were assessed. The last follow-up evaluations were compared between the two groups. Results Elbow range of motion, carrying angle, Baumann angle and humerocapitellar angle were in the normal range for both groups. There was no difference between the two groups. No significant difference was found between the two groups in the percent strength of triceps muscle normalized against the healthy side. Both groups achieved 100 Mayo Elbow Score showing no differences between the groups. Conclusion The triceps-splitting approach and paratricipital approach have comparable clinical results when used to treat tliatfic displaced sunracondvlar humeral fractures.

关 键 词：儿童 骨折固定术 内 肱骨髁上骨折 功能评价 手术入路 

分 类 号：R726.8[医药卫生—儿科]