【作者】 毕梦娜；

【导师】 邓友章；

【作者基本信息】 成都中医药大学 ， 中医骨伤科学， 2011， 硕士

【摘要】 目的：观察中西医结合综合治疗儿童肱骨髁上骨折的疗效,分析其在降低肘内翻的发生率方面的作用机理。方法：收集四川省骨科医院儿童病区2009年收治的97例儿童肱骨髁上骨折患者,所有患者均得以一年的随访。其中男59例,女38例；右侧42例,左侧55例；年龄从1岁到14岁,平均年龄8.34岁；伸直型89例,屈曲型8例,并发尺侧移位87例,并发桡侧移位10例。治疗方法：97例患者均采用手法整复结合尺骨鹰嘴牵引、小夹板、钢托外固定并辅以针灸、按摩、TDP照射治疗等中西医结合的方法进行治疗。观察骨折复位情况、骨折愈合情况、关节屈伸功能的恢复、携带角的丢失等指标。对收集的资料与数据,进行分析。结果：本组病人均得到一年的随访,全组无骨折不愈合、尺神经损伤、骨筋膜室综合症等并发症发生。根据Flynn疗效评价标准：优：骨折解剖对位或接近解剖对位；骨折骨性愈合：肘关节屈伸活动正常或屈伸功能受限<10°,提携角正常或肘内翻<5°：良：介于优与差标准之间；差：骨折畸形愈合,肘关节内翻畸形明显,丧失肘关节屈伸功能≥30°,丧失提携角≥15°。其中优：59例,良：37例,差,37例。总优良率为97.9%,肘内翻发生率为17.5%。远低于国内文献报道的最低发生率33%结论：中西医结合综合治疗儿童肱骨髁上骨折疗效确切,尺骨鹰嘴牵引、手法整复、小夹板结合钢托外固定配合合理的功能锻炼及物理治疗的方法,发挥了优势互补,协同作用,能使骨折获得良好的复位、提高并维持复位后骨折的稳定性,在不同环节消除导致肘内翻的危险因素提高了治疗儿童肱骨髁上骨折的疗效,有效降低了肘内翻的发生率,肘关节外观及功能恢复良好,值得临床推广。更多还原

【Abstract】 Objective:To observe the therapeutic effects of combined treatment with Chinese and western medicine in supracondylar humerus fractures in children. To analyse effect on reducing incidence of cubitus varus.Methods:To collect 97 patients with supracondylar humerus fractures in children. All the patients were fellowed-up for one year. There are 59 boys and 38 girls. The children’s ages range from 1 to 14. There are 89 cases with extension type supracondylar humerus fractures in children,8 cases with flexion type supracondylar fractures in children.87 cases have ulnar deviation,10 cases have radial deviation. Treatment:97 patients were given the therapeutic effects of combined treatment with Chinese and western medicine that includes manipulative reduction、ulna traction、small splint、steel splint combined with acupuncture, massage and TDP treatment. Evaluate the therapeutic effects of combined treatment with Chinese and western medicine in supracondylar humerus fractures in children by observing fracture reduction、fracture healing、bending and stretching function of elbow joint、carrying angle.Results:The patients have followed-up for one year. there are no nonunion、injury of ulnal nerve、Asteofascial compartment syndrome, etal. According with Flynn’s evaluation of therapeutical effect:Excellent: anatomic reduction or closed to anatomic reduction, bony union, bending and stretching function of elbow joint is normal or dysfunctions is less than 10°,carrying angle is normal or cubitus varus is less than 5°,59 cases;Good:between Excellent and poor,37 cases;Poor:malunion, obvious cubitus varus, bending and stretching dysfunction is more than 15°, loss of carrying angle is more than 15°,3 cases. Excellent rate: 97.9%, incidence of cubitus varus:17.5%.Conclusion:Combined treatment with Chinese and western medicine in supracondylar humerus fractures in children is effective. Manipulative reduction、ulna traction、small splint、steel splint combined with acupuncture, massage combined with exercise correctly and physiotherapy supplement each other’s advantages and synergism. they eliminate risk factors of cubitus varus in different link and reduce incidence of cubitus varus. The treatment is worthy of clinic application.更多还原