不同克氏针内固定方法治疗Gartland Ⅲ型儿童肱骨髁上骨折临床疗.docVIP

不同克氏针内固定方法治疗Gartland Ⅲ型儿童肱骨髁上骨折临床疗 　【摘要】 [目的]比较不同克氏针内固定方法治疗Gartland Ⅲ型儿童肱骨髁上骨折的临床疗效。[方法]本组45例，内外侧交叉固定治疗(A组)24例，以及外侧双皮质固定治疗(B组)21例。观测2组骨折肘关节功能、肘内翻等指标，比较临床综合疗效。[结果]肘关节功能评定：A组优12例，良9例，差3例，优良率为87.5%;B组优10例，良6例，差5例，优良率为76.1%。[结论]内外侧交叉固定与外侧双皮质固定具有稳定性高、抗旋转作用强、关节功能恢复快、肘内翻发生率低、临床疗效佳的特点。 【关键词】 肱骨骨折;内固定;儿童;对照研究 　　Abstract：[Objective]To study the clinic effect of different Kirschners wire internal fixation for treatment on Gratland Ⅲ supracondylar fracture of humerus in children.[methods]45 cases of Gartland Ⅲ supracondylar fracture of humerus in children，there were 27 male patients and 18 female patients with the age from 5 to 12 years.The average age was 7.6 years.Group A(exterior and interior crossing internal fixation)24 cases contained 14 male cases and 10 female cases;group B(lateral double cortical internal fixation) 21 cases contained 13 male cases and 8 female cases.We evaluated the function of elbow，cubitus varus and clinic curative effect.[Results]These cases were followedup for 3 months to 3 years.The average time was 25 months.We evaluated the clinical curative effect with the Flynn method.12 cases in group A were excellent;9 cases were good and 3 cases were poor.10 cases in Group B were excellent;6 cases were good and 5 cases were poor.Their fitness was 87.5% and 76.1% respectively.There was no statistical significance.[Conclusion]Exterior and interior crossing internal fixation and lateral double cortical internal fixation have good quality such as good stability，good antirotation，good joint function and cubitus varus. 　　Key words：fracture of humerus;internal fixation;children;control study 　　我们自2004年起，采用克氏针内外侧交叉固定和外侧双皮质固定治疗儿童Gartland Ⅲ型肱骨髁上骨折45例，疗效满意，现报道如下。 　　1 资料与方法 　　1.1 一般资科 本组45例，男27例，女18例;年龄5～12岁，平均7.6岁。致伤原因：均为玩耍或行走时跌伤。骨折类型：均为新鲜闭合GartlandⅢ型，其中尺偏型33例，桡偏型12例;无合并神经血管损伤。受伤到手术时间：2h～7h。 　　1.2 手术方法 　　1.2.1 内外侧交叉固定组(A组) 采用基础加臂丛神经阻滞，驱血后上止血带。于肘关节外侧肱骨外上髁上以骨折线为中心作2～3cm长切口，从肱桡肌、桡侧伸腕肌与肱三头肌之间进入外上髁嵴上切开骨膜，行骨膜下剥离，显露骨折块，特别是冠状窝和鹰嘴窝，尽可能不打开关节囊。然后触摸清楚内上髁，其稍前方作长1～1.5cm切口，暴露尺神经，