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目的:探讨儿童GartlandⅢ型肱骨髁上骨折治疗的最佳手术治疗方案。方法:搜集本院近3年内6～12岁Gart-landⅢ型肱骨髁上骨折患儿38例,随机分为A、B两组。其中A组行克氏针内外交叉内固定,共计20例;B组行外侧平行克氏针内固定,共计18例。定期随访,检查和记录一般感觉运动、末梢血运状况及肘关节功能,对2组术后功能优良率进行比较。结果:2组患儿均达到解剖复位,术后接受12～18个月(平均16个月)的随访,根据Flynn标准评定,2组关节功能优良率分别为90%和94.4%,差异无统计学意义(P>0.05)。2组共4例出现肘内翻畸形,组间无统计学差异,(交叉固定组)出现1例尺神经损伤,外侧固定组未见。结论:针对儿童GartlandⅢ型肱骨髁上骨折,2种克氏针固定方式效果相似,均能达到满意的临床效果。但是外侧平行固定可避免医源性尺神经损伤。
Objective: To investigate the best surgical treatment for Gartland type Ⅲ supracondylar humerus fractures in children. Methods: Thirty-eight children with Gart-land Ⅲ humerus supracondylar fractures aged 6-12 years old were collected in our hospital in the past 3 years and were randomly divided into A and B groups. A group of Kirschner wire internal and external cross-fixation, a total of 20 cases; B group parallel to the outside of Kirschner wire fixation, a total of 18 cases. Regular follow-up, examination and recording of general sensory movement, peripheral blood supply status and elbow function, the postoperative functional rate of 2 groups were compared. Results: The anatomic reduction was achieved in both groups. The patients were followed up for 12 to 18 months (average 16 months). According to the Flynn criteria, the excellent and good rates of joint function in the two groups were 90% and 94.4% respectively, with no statistical difference Significance (P> 0.05). There were 4 cases of cubitus varus deformity in 2 groups. There was no significant difference between the two groups. One (1) ulnar nerve injury occurred in the cross fixation group and no external fixation group. Conclusion: The results of two Kirschner wire fixation methods for Gartland type Ⅲ supracondylar fractures in children are similar, and satisfactory clinical results can be achieved. However, parallel to the lateral fixation to avoid iatrogenic ulnar nerve injury.