【摘要】 目的比较闭合复位外固定架固定与有限切开复位克氏针内固定治疗儿童不可复性肱骨髁上骨折的临床效果。方法选取2014年1月至2016年12月固始县人民医院收治的不可复性肱骨髁上骨折患儿68例,其中36例给予有限切开复位克氏针内固定治疗(内固定组),32例给予闭合复位外固定架固定治疗(外固定组),对2组患儿的手术时间、术后住院时间、骨折愈合时间、Baumann角变化、临床疗效及并发症发生情况进行比较。结果内固定组患儿手术时间及骨折愈合时间分别为(48.9±6.4)min、(53.1±3.4)d,外固定组患儿手术时间及骨折愈合时间分别为(72.4±12.8)min、(76.3±5.5)d,内固定组患儿手术时间及骨折愈合时间显著短于外固定组(P<0.05)。内固定组患儿术毕时、术后3个月时Baumann角分别为(70.9±11.2)°、(68.5±10.2)°,差值为(2.4±1.2)°;外固定组患儿术毕时、术后3月时Baumann角分别为(71.6±10.5)°、(65.4±8.4)°,差值为(6.2±2.0)°;内固定组患儿术后3个月Baumann角变化显著小于外固定组(P<0.05)。内固定组和外固定组患儿治疗效果优良率分别为86.1%(31/36)、62.5%(20/32),内固定组患儿治疗效果优良率显著高于外固定组(χ~2=4.816,P<0.05)。外固定组和内固定组患儿并发症发生率分别为6.3%(2/32)、5.6%(2/36),2组患儿并发症发生率比较差异无统计学意义(χ~2=1.036,P>0.05)。结论有限切开复位克氏针内固定治疗儿童不可复性肱骨髁上骨折具有手术时间短、复位效果好、骨折愈合快、肘关节功能恢复好等优势。更多还原

【Abstract】 Objective To compare the clinical effect of closed reduction with external fixation and limited open reduction with Kirschner wire internal fixation for irreducible humeral supracondylar fracture in children. Methods A total of 68 children with irreducible humeral supracondylar fracture were selected from January 2014 to December 2016 in the People’ s Hospital of Gushi County. Among the children,36 cases were treated with limited open reduction and Kirschner wire external fixation( internal fixation group),and 32 cases were treated with closed reduction and external fixation( external fixation group). The operation time,postoperative hospitalization time,fracture healing time,Baumann angle change,clinical effect and complication were compared between the two groups. Results The operation time and fracture healing time in the internal fixation group was( 48. 9 ± 6. 4) min and( 53. 1 ± 3. 4) d respectively,the operation time and fracture healing time in the external fixation group was( 72. 4 ± 12. 8) min and( 76. 3 ± 5. 5) d respectively,the operation time and fracture healing time in the internal fixation group were significantly shorter than those in the external fixation group( P < 0. 05). The Baumann angle in the internal fixation group at the time points the end of the operation and three months after treatment was( 70. 9 ± 11. 2) ° and( 68. 5 ± 10. 2) ° respectively,and the Baumann angle difference was( 2. 4 ± 1. 2) °; the Baumann angle in the external fixation group at the time points of the end of the operation and three months after treatment was( 71. 6 ± 10. 5) ° and( 65. 4 ± 8. 4) °respectively,and the Baumann angle difference was( 6. 2 ± 2. 0) °; the change of Baumann angle in the external fixation group was significantly smaller than that in the external fixation group within 3 months after operation( P < 0. 05). The fineness rate in the internal fixation group and external fixation group was 86. 1%( 31/36) and 62. 5%( 20/32) respectively,the fineness rate in the internal fixation group was significantly higher than that in the external fixation group( χ~2= 4. 816,P < 0. 05). The incidence of complications in the external fixation group and internal fixation group was 6. 3%( 2/32) and 5. 6%( 2/36) respectively,there was no significant difference in the incidence of complications between the two groups( χ~2= 1. 036,P >0. 05). Conclusion Limited open reduction and Kirschner wire internal fixation in the treatment of irreducible humeral supracondylar fracture in children has the advantages of short operation time,good reduction effect,fast fracture healing and good elbow joint function restoration.更多还原