CAJ | 학술논문

目的：比较经肘内侧小切口切开复位与闭合复位克氏针内固定治疗儿童Gartland Ⅲ型肱骨髁上骨折的疗效。方法我们对2010年7月至2012年12月收治的124例GartlandⅢ型肱骨髁上骨折患儿，分别采用经肘内侧小切口切开复位克氏针内固定（切开复位组）和闭合复位克氏针内固定（闭合复位组）治疗，术后规范随访，比较两组手术时间，术中透视次数，骨折骨性愈合时间，术后3个月、6个月肘关节功能评分以及术后近、远期并发症的发生率。结果切开复位组手术时间（50．2±6.81）min，较闭合复位组短[（81．3±18．98）min]，术中透视次数（3．4±1．1）次，少于闭合复位组[（7.0±2．6）次]，差异有统计学意义（P＜0．05）。切开复位组及闭合复位组于平均术后8周均获得骨性愈合。按照 Flynn 肘关节评分标准评定疗效，术后3个月、6个月切开复位组优良率（分别为86.57％，97．01％）与闭合复位组（78．95％，92．98％）比较，差异均无统计学意义（P＞0．05）。两组术后近、远期并发症的总发生率比较，切开复位组（8．96％）低于闭合复位组（28．07％），差异有统计学意义（P＜0．05）。结论经肘内侧小切口切开复位治疗Gartland Ⅲ型肱骨髁上骨折手术时间短，术中透视次数少，术后总体并发症发生率低，可获得与闭合复位相似的肘关节功能，是治疗Gartland Ⅲ型肱骨髁上骨折简单、安全、有效的治疗方法。
목적：비교경주내측소절구절개복위여폐합복위극씨침내고정치료인동Gartland Ⅲ형굉골과상골절적료효。방법아문대2010년7월지2012년12월수치적124례GartlandⅢ형굉골과상골절환인，분별채용경주내측소절구절개복위극씨침내고정（절개복위조）화폐합복위극씨침내고정（폐합복위조）치료，술후규범수방，비교량조수술시간，술중투시차수，골절골성유합시간，술후3개월、6개월주관절공능평분이급술후근、원기병발증적발생솔。결과절개복위조수술시간（50．2±6.81）min，교폐합복위조단[（81．3±18．98）min]，술중투시차수（3．4±1．1）차，소우폐합복위조[（7.0±2．6）차]，차이유통계학의의（P＜0．05）。절개복위조급폐합복위조우평균술후8주균획득골성유합。안조 Flynn 주관절평분표준평정료효，술후3개월、6개월절개복위조우량솔（분별위86.57％，97．01％）여폐합복위조（78．95％，92．98％）비교，차이균무통계학의의（P＞0．05）。량조술후근、원기병발증적총발생솔비교，절개복위조（8．96％）저우폐합복위조（28．07％），차이유통계학의의（P＜0．05）。결론경주내측소절구절개복위치료Gartland Ⅲ형굉골과상골절수술시간단，술중투시차수소，술후총체병발증발생솔저，가획득여폐합복위상사적주관절공능，시치료Gartland Ⅲ형굉골과상골절간단、안전、유효적치료방법。
Objetive To compare the clinical effects of open reduction with elbow medial minimalinci-sion approach versus closed reduction in the treatment of supracondylar humerus fractures (Gartland Ⅲ)in children. Methods 124 patients who had been treated for supracondylar humerus fractures in our department from July 2010 to December 2012 were selected in this study.Sixty-seven patients were treated with open reduc-tion via a elbow medial minimalincision(open reduction group)while the other fifty-seven with closed reduction (closed reduction group).The two groups were compared in terms of operative time,intraoperative radiography frequency,fracture healing time,Flynn elbow scoring at 3 and 6 months postoperation as well as complications. Results 124 patients were followed up,and the duration ranged from 6 to 32 months,with a mean of 18.5 months.Compared with the closed reduction group,the open reduction group needed significantly shorter average operative time (50.2 ±6.81minutes versus 81.3 ±18.98 minutes)and lower average intraoperative radio-graphy frequency(3.4 ±1.1 times versus 7.0 ±2.6 times)(P<0.05).All the fractures achieved bony union at 8 weeks post-operation.By the Flynn elbow scorning at 3 months and 6 months post-operation,the good to ex-cellent rate was 86.57%and 97.01%respectively in the open reduction group while 78.95%and 92.98%in the closed reduction group,with no significant difference (P>0.05 ).16 patients with various complications such as compartment syndrome,iatrogenic lesions to nerves or cubitus varus occurred in closed reduction group, meanwhile,only 6 patients in open reduction group,the diffence between the two groups is significant (P<0.05 ). Conclusion In treatment of supracondylar humerus fractures(Gartland Ⅲ)in children,both open re-duction via a elbow medial minimalincision and closed reduction can lead to fracture healing in similar time and similar functional recovery of elbow.However,open reduction with a elbow medial minimalincision approach can result in shorter operative time,lower introperative radiography frequency and lower complication rates.It is a safe,less invasive and satisfactory treatment method.