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目的针对西藏高海拔地区儿童肱骨髁上骨折损伤重、就诊延误、院前处置匮乏、依从性不足的特点,分析肘部外侧小切口复位经皮交叉克氏针固定和闭合复位石膏托固定治疗GartlandⅡ型和Ⅲ型骨折的近期疗效。方法回顾性分析2011年6月至2015年12月收治并获4个月随访的63例GartlandⅡ型、Ⅲ型儿童肱骨髁上骨折资料,病例按患者意愿分为AB两组,A组为手术治疗组(肘部外侧小切口复位经皮交叉克氏针固定)37例,男23例,女14例;年龄4~14岁,平均年龄7.16岁;GartlandⅡ型11例,GartlandⅢ型26例。B组为保守治疗组(闭合复位石膏托固定)26例,男15例,女11例;年龄4~11岁,平均年龄6.77岁;GartlandⅡ型14例,GartlandⅢ型12例。比较两组末次随访时的疗效、功能评分、并发症。结果 AB两组病例均获4个月随访。AB两组病例骨折均愈合,无Volkmann挛缩和异位骨化,治疗前后有神经损伤者均恢复功能。按照Mayo评分标准,两组在疗效、优良率和功能评分比较P<0.05,差异有统计学意义,A组优于B组;GartlandⅡ型骨折疗效比较P>0.05,两组间差异无统计学意义,A组与B组疗效无差异;GartlandⅢ型骨折疗效比较P<0.05,两组间差异有统计学意义,A组优于B组;复位丢失、肘内翻方面相比较P<0.05,两组间差异有统计学意义,A组少于B组;神经损伤和伤口感染,两组间差异无统计学意义。结论基于西藏高海拔地区儿童肱骨髁上骨折特点,肘部外侧小切口复位经皮交叉克氏针固定在疗效、优良率和功能评分方面均具有优势,并发症少,易于开展。GartlandⅡ型骨折建议手术,GartlandⅢ型骨折需要手术。
Objective To analyze the injury of supracondylar fractures of humerus in Tibet at high altitude, delay of treatment, lack of pre-hospitalization and lack of compliance, and to analyze the effect of GatlandⅡ Type and type Ⅲ fracture in the near future. Methods The data of 63 cases of Gartland Ⅱ and Ⅲ supracondylar humerus fractures admitted to our hospital from June 2011 to December 2015 were retrospectively analyzed. The cases were divided into two groups according to the patients’ wishes. The patients in group A received surgical treatment Thirty-seven patients (23 males and 14 females) aged 4-14 years with a mean age of 7.16 years were included in the study group (11 cases of Gartland Ⅱ type and 26 cases of Gartland Ⅲ type). Group B was conservative treatment group (closed reduction plaster for fixation) 26 cases, 15 males and 11 females; aged 4 to 11 years, mean age 6.77 years; Gartland Ⅱ type 14 cases, Gartland Ⅲ type 12 cases. The curative effect, functional score and complications of the two groups at the last follow-up were compared. Results The two groups of patients were followed up for 4 months. AB fracture healing in both groups, no Volkmann contracture and heterotopic ossification, before and after treatment were nerve damage were restored. According to the Mayo scale, the curative effect, excellent rate and functional score of the two groups were compared, P <0.05, the difference was statistically significant, A group was better than the B group; Gartland Ⅱ fracture efficacy comparison P> 0.05, the difference between the two groups was not statistically significant , There was no significant difference between group A and group B. The efficacy of Gartland type Ⅲ fracture was significantly lower than that of group B (P <0.05), the difference was statistically significant The difference between the two groups was statistically significant, while group A was less than group B.Nerve injury and wound infection had no significant difference between the two groups. Conclusion Based on the characteristics of supracondylar fractures of humerus in children in high altitude areas of Tibet, the small cross-sectional reduction of percutaneous cross-over Kirschner wire fixation has the advantages of excellent curative effect, excellent rate and functional score with few complications and easy to carry out. Gartland type II fractures recommended surgery, Gartland type Ⅲ fractures require surgery.