尺骨鹰嘴牵引与闭合复位克氏针内固定治疗GartlandⅢ型儿童伸直型肱骨髁上骨折的疗效比较  

Comparison of Ulnar Olecranon Traction and Closed Reduction and Kirschner Wire Internal Fixation in the Treatment of Gartland TypeⅢSupracondylar Fracture of Humerus in Children

作　　者：韩大栋 张德华 涂迪 张磊 HAN Da-dong;ZHANG Dehua;TU Di;ZHANG Lei(Department of Osteology and Joint Surgery,Shiyan Renmin Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]十堰市人民医院·湖北医药学院附属人民医院骨关节科,湖北十堰442000

出　　处：《湖北医药学院学报》2023年第1期35-39,共5页Journal of Hubei University of Medicine

摘　　要：目的:对比手法复位、夹板固定配合尺骨鹰嘴牵引和闭合复位克氏针内固定治疗GartlandⅢ型儿童伸直型肱骨髁上骨折的临床疗效。方法:通过回顾性研究我院2019年6月至2020年9月期间收治的GartlandⅢ型伸直型肱骨髁上骨折患儿60例,使用手法复位后夹板固定配合尺骨鹰嘴牵引治疗30例,另外30例采用闭合复位克氏针内固定治疗。术后3个月分别比较两组患儿Baumann角、屈曲、伸直、旋前、旋后角度及肘关节功能评分,并比较两组治疗方式的并发症发生情况及骨折愈合时间。结果:两种方法治疗均无肘内翻畸形发生,骨折均愈合良好,无延迟愈合或不愈合发生。两组病例Baumann角、屈曲、旋前及旋后角度的差异无统计学意义,克氏针固定组骨折愈合更快,差异有统计学意义。对于两组复位后3个月的Flynn肘关节功能评定疗效,两组肘关节功能恢复差异无统计学意义。两组病例均发生了针道感染,但经抗感染、换药后均好转;尺骨鹰嘴牵引组发生1例尺神经牵拉刺激,去除牵引后好转,克氏针固定组发生1例尺神经损伤,3个月后逐渐恢复。结论:手法复位、夹板固定配合尺骨鹰嘴牵引治疗GartlandⅢ型儿童伸直型肱骨髁上骨折也能取得良好临床疗效,肘关节功能恢复同闭合复位克氏针内固定相比无明显差异,降低了患儿射线曝露及手术麻醉的风险,同时具有创伤小、操作简单且风险低的优势,为治疗GartlandⅢ型儿童伸直型肱骨髁上骨折提供了一种新方法,在临床上有一定的推广价值。Objective To compare the clinical efficacy of manual reduction,splint fixation combined with olecranon traction and closed reduction Kirschner wire internal fixation in the treatment of Gartland typeⅢextended supracondylar fractures of humerus in children.Methods A retrospective study was conducted on 60 children with Gartland typeⅢextended supracondylar fractures in our hospital from June 2019 to September 2020.30 cases were treated with manual reduction followed by splint fixation and olecranon traction,and the other 30 cases were treated with closed reduction Kirschner wire internal fixation.Baumann angle,flexion,extension,pronation,supination angle and elbow joint function score were compared between the two groups 3 months after surgery,and the incidence of complications and fracture healing time were compared between the two groups.Results No elbow varus deformity occurred in the long term and the fracture healed well without delayed union or non-union.There were no statistically significant differences in Baumann angle,flexion,pronation and supination angle between the two groups,while the Kirschner wire fixation group had faster fracture healing and the difference was statistically significant.There was no significant difference in the functional recovery of Flynn’s elbow between the two groups 3 months after reduction.Needle tract infection occurred in both groups,but improved after anti-infection,dressing change and needle removal.In the olecranon traction group,there was 1 case of ulnar nerve traction stimulation,which improved after removal of traction;in the Kirschner wire fixation group,there was 1 case of ulnar nerve injury,which gradually recovered after 3 months.Conclusion Manipulative reduction,splint fixation combined with olecranon traction can also achieve good clinical efficacy in the treatment of Gartland typeⅢchildren’s extended supracondylar fractures of the humerus.The long-term recovery of elbow joint function has no significant difference compared with closed reduction Kirsch

关 键 词：尺骨鹰嘴牵引 闭合复位 克氏针内固定 GartlandⅢ型 儿童肱骨髁上骨折 

分 类 号：R726.8[医药卫生—儿科]