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目的观察手法复位、克氏针固定辅以单味桂枝煎汤内服治疗小儿肱骨远端Gartland Ⅲ型骨折的临床疗效。方法将70例肱骨远端Gartland Ⅲ型骨折患儿随机分为治疗组和对照组,各35例。2组患儿均接受骨折急诊手法复位、克氏针固定、管型石膏固定。治疗组在对照组治疗方法的基础上给予单味中药桂枝煎汤口服,中药给药时间为术后1周及石膏拆除后1周。观察2组患儿固定位置伤肢周径和肘关节屈伸活动度。结果治疗组术后第7天上肢肿胀测量周径与对照组比较,差异有统计意义(t=1.15,P<0.05);拆除石膏1周后2组上肢肿胀测量周径比较,差异有统计意义(t=2.74,P<0.05)。石膏拆除48 h后,2组患儿患肢均存在僵硬,肘关节活动度比较差异无统计意义(P>0.05);石膏拆除1周后,2组肘关节活动度比较差异有统计意义(t=4.18,P<0.05)。所有患儿接受治疗后均顺利康复,无严重不良并发症或后遗症,无肘内翻畸形。对照组患儿有4例在术后出现伤肢张力性水疱,3例出现伤肢指端循环轻度障碍,均自然缓解,无特殊处理;治疗组患儿无张力性水疱及末梢循环异常。结论手法复位、克氏针固定辅以单味桂枝煎汤内服治疗小儿肱骨远端Gartland Ⅲ型骨折具有良好的临床疗效。
Objective To observe the clinical effect of manual reduction and Kirschner wire fixation combined with single Guizhi decoction orally for the treatment of distal Gartland Ⅲ fracture of the humerus in children. Methods Seventy children with distal Gartland Ⅲ fracture of humerus were randomly divided into treatment group and control group, with 35 cases in each group. Two groups of children underwent fracture reduction in emergency procedures, Kirschner wire fixation, cast immobilization. The treatment group was given oral administration of Guizhi Jintang, a traditional Chinese medicine, on the basis of the control group. The administration time of traditional Chinese medicine was 1 week after operation and 1 week after the removal of gypsum. The fixed position of the injured limbs and elbow flexion and extension activities in the two groups were observed. Results Compared with the control group, the peripheral diameter of upper limb swelling on the 7th day after operation in the treatment group was statistically significant (t = 1.15, P <0.05); after 1 week of removal of gypsum, (t = 2.74, P <0.05). There was no significant difference in elbow mobility between the two groups (P> 0.05) after 48 hours of gypsum removal. There was significant difference in elbow mobility between the two groups = 4.18, P <0.05). All children were well recovered after treatment, no serious adverse complications or sequelae, no cubitus deformity. There were 4 cases of tension blisters in the control group and 3 cases of slight dyskinesia of the injured limbs after the operation, which were relieved spontaneously without any special treatment. The children in the treatment group had no abnormalities of blistering and peripheral circulation. Conclusions Manual reduction, Kirschner wire fixation combined with single Guizhi decoction oral treatment of pediatric distal humeral Gartland Ⅲ fracture has a good clinical effect.