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目的比较闭合复位与切开复位经皮克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折的疗效。方法回顾性分析自2015-01—2015-12诊治的16例GartlandⅢ型儿童肱骨髁上骨折,采用闭合复位经皮克氏针内固定9例(闭合复位组),切开复位经皮克氏针内固定7例(切开复位组)。比较2组手术时间、住院时间、末次随访时肘关节功能Flynn评分。结果切开复位组手术时间明显短于闭合复位组,但住院时间长于闭合复位组,差异有统计学意义(P<0.05)。16例均获得随访6~12个月,平均8个月。骨折均愈合,无血管神经损伤、骨筋膜室综合征、钉道感染、骨化性肌炎等并发症发生,仅闭合复位组1例出现肘内翻畸形。末次随访时,闭合复位组肘关节功能Flynn评分低于切开复位组,差异有统计学意义(P<0.05)。结论对于GartlandⅢ型儿童肱骨髁上骨折,首选治疗方法为闭合复位经皮克氏针内固定,但对于有明显血管神经损伤、闭合复位失败者则需要及时行切开复位内固定。
Objective To compare the curative effect of closed reduction and open reduction and percutaneous Kirschner wire fixation for supracondylar fractures of Gartland type Ⅲ children. Methods 16 cases of Gartland type Ⅲ children with supracondylar humerus fractures diagnosed and treated from January 2015 to December 2015 were retrospectively analyzed. Nine patients (closed reduction group) underwent closed reduction and percutaneous Kirschner wire fixation were treated with open reduction and percutaneous Kirschner wire Internal fixation in 7 cases (open reduction group). The operation time, hospitalization time and the Flynn score of elbow joint function at the last follow-up were compared. Results The operation time of open reduction group was significantly shorter than that of closed reduction group, but the hospitalization time was longer than that of closed reduction group, the difference was statistically significant (P <0.05). All 16 patients were followed up for 6 to 12 months with an average of 8 months. Fractures were healed, no vascular nerve injury, compartment syndrome, nostril infection, ossification myositis and other complications occurred, only closed reduction group 1 case of cubitus varus deformity. At the last follow-up, the Flynn score of the elbow joint in the closed reduction group was lower than that in the open reduction group (P <0.05). Conclusion For Gartland type Ⅲ children with supracondylar humerus fractures, the preferred treatment is closed reduction percutaneous Kirschner wire fixation, but for obvious vascular nerve injury, the failure of closed reduction needs immediate open reduction and internal fixation.