测量Baumann角判断复位在克氏针固定治疗儿童Gartland Ⅲ型肱骨髁上骨折中的应用  

Applications of Baumann angle measurement in judging reduction of Gartland type Ⅲ humeral supracondylar fractures in children after Kirschner wire fixation

作　　者：张启锋 杨将 张鹏程 施海泉 

机构地区：[1]南通市通州中医医院骨科,江苏南通226300

出　　处：《骨科》2015年第5期256-260,共5页ORTHOPAEDICS

摘　　要：目的 探讨测量Baumann角（the Baumann angle,BA）判断复位在交叉克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折的应用。方法 回顾性分析2010年6月至2013年3月,我院收治并获随访的利用BA判断复位的交叉克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折患者58例,根据手术方案不同分为闭合复位内固定（closed reduction and percutaneous pinning,CRPP）组（33例）和切开复位内固定（open reduction and internal fixation,ORIF）组（25例）。对两组在住院期间、拆除石膏后和末次随访时的BA以及肘内翻发生率等进行比较,以Flynn肘关节功能评价标准评估治疗效果。结果 本组患者获随访12.0~45.0个月（平均14.7个月）。58例患者均骨性愈合,无切口或针道感染、血管神经损伤、骨化性肌炎、Volkmann缺血性肌挛缩等并发症。CRPP组肘内翻发生率12.12%,肘关节功能优良率84.85%;ORIF组肘内翻发生率8.00%,肘关节功能优良率84.00%,两组的肘内翻畸形发生率、关节功能优良率差异均无统计学意义（均P〉0.05）。但复位后BA≥80°与〈80°的患者的肘内翻发生率差异有统计学意义（P〈0.05）。结论 复位后及时测量BA,以其是否〈80°作为标准判断是否予以纠正复位,再行微创克氏针内固定是治疗儿童肱骨髁上骨折一种疗效可靠的方法。Objective To investigate the applications of Baumann angle （BA） measurement in judging reduction of Gartland type Ⅲ humeral supracondylar fractures in children with Kirschner wire fixation. Methods Fifty-eight children with Gartland type Ⅲ humeral supracondylar fractures in our hospital from Juru 2010 to Mar. 2013, using BA measurement to judge reduction in Kirschner wire fixa- tion, were retrospectively analyzed. The children were divided into a closed reduction and percutaneous pinning （CRPP） group （33 cases） and an open reduction and internal fixation （ORIF） group （25 cases） according to the surgical procedures. The data for BA and cubitus varus rate of the 2 groups during hospitalization, after plaster removal, and at final follow-up were compared. Flynn elbow functional evaluation criteria were adopted to assess therapeutic effects. Results The patients in this study were followed up for 12. 0-45. 0 months （mean 14. 7 months）. All 58 patients exhibited bony union, without complications such as incision or pin tract infection, vascular or neurological injury, myositis ossificans, or Volkmann ischemic contracture, etc. The incidence of cubitus varus in the CRPP group was 12. 12%, with a rate of excellent elbow function of 84. 85 %. The ORIF group exhibited an incidence of cubitus varus of 8. 00%, and a rate of excellent elbow function of 84. 00%. The cubitus varus incidence and excellent elbow function rate between groups showed no statistically significant difference （P〈0. 05）. However, the difference in cubitus varus incidence between patients with postreduction BA≥80° and 80° was statistically significant （P〈0. 05）. Conclusion Post-reduction measurement should set BA〈80° as the criterion for judging the need for reduction correction, as well as for follow up of minimally invasive Kirschner wire fixation. This can be used as a surgical method with reliable efficacy in treating children with humeral supracondylar fractures.

关 键 词：肘关节 肱骨骨折 骨折固定术 内 儿童 放射摄影术 

分 类 号：R726.8[医药卫生—儿科]