CAJ | 학술논문

目的：观察复位架牵引下手法复位经皮穿针内固定治疗儿童肱骨髁上骨折的临床疗效。方法：将符合要求的60例肱骨髁上骨折患者随机分为复位架组和手法复位组，每组30例。复位架组采用复位架牵引下手法复位经皮穿针内固定治疗，手法复位组采用手法复位经皮穿针内固定治疗。比较2组患者的手术时间、住院时间、肘内翻发生率及临床疗效。临床疗效评价采用《中医病证诊断疗效标准》中肱骨髁上骨折的疗效标准。结果：复位架组的手术时间和住院时间均比手法复位组短[（33．73±10．33）min，（40．55±9．44）min，t ＝9．223，P ＝0．000；（13．95±2．96）d，（17．75±4．10）d，t ＝1．425，P ＝0．037]。术后6周时共有3例患者失访（复位架组1例、手法复位组2例），复位架组9例发生肘内翻、手法复位组15例发生肘内翻，2组患者肘内翻的发生率比较，差异无统计学意义（χ2＝2．968，P ＝0．085）；复位架组治愈20例、好转9例，手法复位组治愈13例、好转15例，2组患者的临床疗效比较，差异无统计学意义（Z ＝－1．708，P ＝0．088）。结论：复位架牵引下手法复位经皮穿针内固定术治疗儿童肱骨髁上骨折疗效确切，并可有效缩短手术时间及住院时间，值得临床推广应用。
목적：관찰복위가견인하수법복위경피천침내고정치료인동굉골과상골절적림상료효。방법：장부합요구적60례굉골과상골절환자수궤분위복위가조화수법복위조，매조30례。복위가조채용복위가견인하수법복위경피천침내고정치료，수법복위조채용수법복위경피천침내고정치료。비교2조환자적수술시간、주원시간、주내번발생솔급림상료효。림상료효평개채용《중의병증진단료효표준》중굉골과상골절적료효표준。결과：복위가조적수술시간화주원시간균비수법복위조단[（33．73±10．33）min，（40．55±9．44）min，t ＝9．223，P ＝0．000；（13．95±2．96）d，（17．75±4．10）d，t ＝1．425，P ＝0．037]。술후6주시공유3례환자실방（복위가조1례、수법복위조2례），복위가조9례발생주내번、수법복위조15례발생주내번，2조환자주내번적발생솔비교，차이무통계학의의（χ2＝2．968，P ＝0．085）；복위가조치유20례、호전9례，수법복위조치유13례、호전15례，2조환자적림상료효비교，차이무통계학의의（Z ＝－1．708，P ＝0．088）。결론：복위가견인하수법복위경피천침내고정술치료인동굉골과상골절료효학절，병가유효축단수술시간급주원시간，치득림상추엄응용。
Objective:To observe the clinical curative effect of reduction frame traction combined with manipulative reduction and percu-taneous Kirschner wire internal fixation in the treatment of humeral supracondylar fractures in children.Methods:Sixty patients with humeral supracondylar fractures enrolled in the study were randomly divided into reduction frame group and manipulative reduction group,30 cases in each group.The patients in reduction frame group were treated with reduction frame traction combined with manipulative reduction and percu-taneous Kirschner wire internal fixation,while the others in manipulative reduction group were treated with manipulative reduction combined with percutaneous Kirschner wire internal fixation.The operative time,hospital stay,incidence rate of cubitus varus and clinical effects were compared between the 2 groups,and the curative effects were evaluated according to the therapeutic effect criterion of humeral supracondylar fracture which was extracted from Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes. Results:The operative time and hospital stay of reduction were shorter in reduction frame group compared to manipulative reduction group (33.73 +/-10.33 vs 40.55 +/-9.44 min,t =9.223,P =0.000;13.95 +/-2.96 vs 17.75 +/-4.10 days,t =1.425,P =0.037).One patient in reduction frame group and 2 patients in manipulative reduction group lost to follow -up 6 weeks after the operation,and cubitus varus were found in reduction frame group(9 cases)and manipulative reduction group(15 cases).There was no statistical difference in the incidence rate of cubitus varus between the 2 groups(χ2 =2.968,P =0.085).Twenty patients obtained an excellent result and 9 good in the reduction frame group,while 13 patients obtained an excellent result and 15 good in the manipulative reduction group,and there was no statistical difference in the clinical curative effect between the 2 groups(Z =-1.708,P =0.088).Conclusion:The clinical curative effect of reduction frame traction combined with manipulative reduction and percutaneous Kirschner wire internal fixation is definite for treatment of humeral supracondylar frac-tures in children,and the operative time and hospital stay can be shortened effectivity,so it is worthy of popularizing in clinic.