肱骨髁上骨折解剖与功能复位早期临床功能的比较研究  

Differential anatomical or functional reduction of early clinical outcome for supracondylar humeral fractures

作　　者：冯伟[1] 王强[1] 宋宝健[1] 朱丹江[1] Feng Wei;Wang Qiang;Song Baojian;Zhu Danjiang(Department of Orthopedics,Affiliated Beijing Children s Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院骨科,北京市100045

出　　处：《临床小儿外科杂志》2018年第10期50-54,共5页Journal of Clinical Pediatric Surgery

基　　金：北京市医院管理局"扬帆计划"(编号:XMLX201837)

摘　　要：目的探讨儿童Ⅲ型肱骨髁上骨折行闭合复位克氏针内固定解剖复位与功能复位术后早期临床功能的差异。方法选择首都医科大学附属北京儿童医院2016年1月至2017年6月采用闭合复位经皮克氏针内固定治疗的Ⅲ型肱骨髁上骨折患儿作为研究对象。依据复位标准分为解剖复位组与功能复位组。观察术后6周、8周、12周肘关节屈伸功能恢复趋势,并以术后12周为观察终点,比较不同复位效果下早期临床功能的差异。结果随访62例患儿,其中解剖复位42例,功能复位20例。术后6周、8周、12周,解剖复位组伸肘角度丢失值分别为(34. 64±6. 93)°、(29. 05±6. 37)°、(11. 31±5. 19)°,屈肘角度丢失值分别为(29. 05±5. 76)°、(20. 60±6. 55)°、(10. 24±5. 52)°,功能复位组伸肘角度丢失值分别为(39. 75±6. 17)°、(25. 25±7. 34)°、(16. 50±6. 30)°,屈肘角度丢失值分别为(32. 25±5. 45)°、(24. 75±5. 25)°、(14. 00±7. 36)°。以术后12周为早期观察终点,比较两组伸肘角度丢失值,差异有统计学意义(t=-3. 433,P=0. 001);比较屈肘角度丢失值,差异有统计学意义(t=-2. 247,P=0. 028);两组患儿提携角度分别为(4. 29±3. 76)°和(4. 50±3. 59)°,差异无统计学意义(t=-0. 213,P=0. 832)。结论肱骨髁上骨折解剖复位与功能复位后肘关节屈伸功能均随术后时间的延长而逐渐改善;但在术后早期,解剖复位肘关节屈伸功能优于功能复位。因此,相对于功能复位,解剖复位可以获得更好的早期肢体功能和临床疗效。Objective To compare the early outcomes between anatomical and functional reduction in closed reduction and percutaneous pin fixation for children with Gartland III supracondylar humeral fractures.Methods A retrospective review was conducted for 62 children with Gartland III supracondylar humeral fractures undergoing closed reduction and percutaneous pin fixation from January 2016 to June 2017.Based upon the reduction criteria,they were divided into anatomic and functional reduction groups.The flexional and extensional functions of elbow joint were evaluated at 6,8 and 12 weeks post-operation and the outcomes compared at 12 weeks post-operation for anatomical and functional reduction groups.Results There were 42 children with anatomical reduction and another 20 with functional reduction.In anatomical reduction group,the loss value of elbow extension angle was(34.6±6.93)°,(29.05±6.37)°and(11.31±5.19)°at 6,8 and 12 weeks post-operation and the loss value of elbow flexion angle(29.05±5.76)°,(20.60±6.55)°and(10.24±5.52)respectively.In functional reduction group,the loss value of elbow extension angle was(39.75±6.17)°,(25.25±7.34)°and(16.50±6.30)°at 6,8 and 12 weeks post-operation and the loss value of elbow flexion angle(32.25±5.45)°,(24.75±5.25)°and(14.00±7.36)°respectively.At 12 weeks post-operation,both loss value of elbow extension and flexion angle were statistically significant between two groups(t=-3.433,P=0.001 and t=-2.247,P=0.028).Whereas,the loss value of humeral-ulnar angle was 4.29±3.76°and 4.50±3.59°respectively in two groups at 12 weeks post-operation.And it was not statistically significant(t=-0.213,P=0.832).Conclusion Elbow flexional and extensional function both improve gradually after anatomical and functional reductions.However,elbow flexional and extensional function both improve gradually after anatomical and functional reductions.Anatomical reduction is superior to functional reduction during early postoperative period.No significant difference exists in humeral-u

关 键 词：肱骨髁上骨折 解剖 功能复位 儿童 

分 类 号：R726.8[医药卫生—儿科]