目的: 探讨儿童创伤性肱骨髁上骨折（GartlandⅢ型）在采用布巾钳尺骨鹰嘴牵引进行骨折块复位的基础上结合克氏针不同布局内固定法的临床应用,并通过影像学指标分析不同方案的实用性。方法: 于2021年5月―2022年5月纳入本院创伤性肱骨髁上骨折（GartlandⅢ型）儿童患者83例进行研究,按采用的复位及内固定方法进行分组,所有患者借助布巾钳进行尺骨鹰嘴牵引复位,并采用不同克氏针[扇形固定组（牵引+克氏针扇形固定,n=39）、交叉固定组（牵引+克氏针交叉固定,n=44）]进行内固定治疗,观察愈合情况、屈伸度与提携角丢失情况、超声血流参数、神经功能恢复和关节功能恢复及并发症发生状况。结果: 扇形固定组术后骨痂形成时间、骨折愈合时间明显短于交叉固定组;扇形固定组与交叉固定组在屈伸度、提携角丢失情况方面无明显差异;两组术后4、8周点阻力指数（resistance index,RI）有差异,扇形固定组与交叉固定组比较,RI较低,且扇形固定组与交叉固定组的RI降低趋势有差异;扇形固定组在神经功能恢复方面优于交叉固定组;两组在疼痛、稳定性、运动功能和日常活动及关节功能总分方面比较无明显差异;扇形固定组与交叉固定组再移位、肘内翻、感染及医源性神经损伤发生情况比较无明显差异。结论: 儿童创伤性肱骨髁上骨折（GartlandⅢ型）采用布巾钳尺骨鹰嘴牵引联合克氏针扇形与交叉内固定均可有效维持骨折复位和恢复关节功能,但是扇形固定在促进愈合和血管神经恢复方面可能相对较优。
Abstract
Objective To investigate the clinical application of different internal fixation methods of Kirschner wire in children with traumatic supracondylar fracture of humerus (Gartland type III) based on the reduction of fracture fragments by using towel clamp olecranon traction, and to analyze the practicability of different regimens through imaging indicators. Methods From May 2021 to May 2022, 83 children with traumatic supracondylar fracture of humerus (Gartland type III) in the hospital were enrolled in the study. The above patients were grouped according to the reduction and internal fixation methods. All patients were treated with olecranon traction reduction with towel clamp and adopted internal fixation with different Kirschner wires [fan-shaped fixation group (traction + Kirschner wire fan-shaped fixation, n=39), cross-fixation group (traction + Kirschner wire cross-fixation, n=44) ]. The healing status, loss status of flexion and extension and carrying angle, ultrasonic blood flow parameters, neurological function recovery, joint function recovery and complications were observed. Results The postoperative callus formation time and fracture healing time in the fan-shaped fixation group were significantly shorter than those in the cross-fixation group. There were no significant differences in the loss of flexion and extension and the loss of carrying angle between the fan-shaped fixation group and the cross-fixation group. There was a significant difference in the resistance index (RI) between groups at 4 and 8 weeks after surgery, and the RI in the fan-shaped fixation group was lower, and the decrease of RI was different in the fan-shaped fixation group and the cross-fixation group. The recovery of neurological function in the fan-shaped fixation group was better than that in the cross-fixation group. No significant differences were shown in pain, stability, motor function, daily activities and total score of joint function between groups. There were no significant differences in the incidence of redisplacement, cubitus varus, infection and iatrogenic nerve injury between fan fixation group and cross fixation group. Conclusion For traumatic supracondylar humeral fractures (Gartland type Ⅲ) in children, both towel clamp olecranon traction combined with Kirschner wire fan-shaped fixation and cross Kirschner wire internal fixation can effectively maintain fracture reduction and restore joint function, but fan-shaped fixation may be relatively better in promoting healing and vascular nerve recovery.
关键词
肱骨髁上骨折 /
闭合复位 /
尺骨鹰嘴牵引 /
克氏针 /
影像学
Key words
supracondylar fracture of humerus /
closed reduction /
olecranon traction /
kirschner wire /
imaging
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