肱骨髁上骨折治疗中预防肘内翻的临床研究（附76例临床病例分析）

【作者】 魏世隽；

【导师】 熊昌源；

【作者基本信息】 湖北中医学院 ， 中医骨伤科学， 2003， 硕士

【摘要】 目的 研究肱骨髁上骨折有效的治疗方法以及降低肘内翻的发生率。 方法 共收集总结了76例资料较完整的肱骨髁上骨折的治疗，采用非手术疗法64例且分为：手法复位+小夹板固定31例(A组)、手法复位+石膏托固定24例(B组)、尺骨鹰嘴牵引+小夹板固定9例(C组)；采用手术疗法12例(D组)。对四个组肘关节伸屈功能优良率和肘内翻发生率进行分析比较，并作统计学处理，着重对肘内翻的预防加以探讨。 结果 所有病例经随访证实，通过摄患侧肘关节标准正侧位X光片，测量鲍曼氏角(BA角)，并参照郭仲华等对肱骨髁上骨折疗效标准的评判：A组伸屈肘功能优良率96.77％，肘内翻发生率6.46％；B组伸屈肘功能优良率70.83％)，肘内翻发生率8.34％；C组伸屈肘功能优良率88.89％，肘内翻发生率11.11％；D组伸屈肘功能优良率41.66％，肘内翻发生率16.66％。肘关节功能：非手术治疗组(A、B、C)明显优于手术治疗组(D)，P＜0.01，有显著性差异，A组(96.77％)稍优于B组(70.83％)和C组(88.89％)，P＞0.05，无显著性差异。肘内翻：非手术治疗组(A、B、C)稍优于手术治疗组(D)，P＞0.05，无显著性差异。 结论 闭合复位外固定仍然是小儿肱骨髁上骨折十分有效的治疗方法，手术适应征仍应严格掌握。对于并发症肘内翻的预防应贯穿于骨折复位、固定、复查的始终。正确的复位方法和合理的固定方式，无论对保证肘关节的功能还是降低肘内翻的发生率均是关键。更多还原

【Abstract】 ObjectiveTo discuss effective therapy methods for supracondylar fracture in children and how to reduce the incidence rate of cubitus varus.Methods76 cases of supracondylar fracture in children were collected and therapeutic efficacy were analysised. they were respectively treated with nonoperative therapy(61 cases) and operative therapy (D group, 12 cases); and in nonoperative therapy group: 31 cases were treated with maneuver reduction and splint fixation (A group); 24 cases were treated with maneuver reduction and plaster fixation (B group); 9casea were treated with olecranon of ulnar bone traction and splint fixation (C group). The therapeutic efficacy were compared, analysised and treat with statistical method between the four groups.ResulesThe 76 cases had follow-up of 4~24 months . with an average of 14 months. X-ray examination with the A-P and lateral views, reveal B A angle, the excellent rate of joint function in group A is 96.77% ,group B is 70.83% , group C is 88.89% , group D is 41.66% .The result of statistical treatment demonstreated that the difference between the nonoperative therapy group and operative therapy group has statistical significance(P<0.01) and that the difference between the three nonoperative therapy group has no statistical significance(P>0.05).The rate of occurrence of cubitus varus in group A is 6.46% ,group B is 8.34% , group C is 11.11% , group D is 16.66%. The result of statistical treatment demonstreated that the difference between the nonoperative therapy group and operative therapy group has no statistical significance(P>0.05).ConclusionThe maneuver reduction and external fixation is the very effective therapy method for supracondylar fracture in children. The operative must be selected strictly. Reducing the incidence rate of cubitus varus must span in the course of reduction and fixation. The key to preventing cubitus varus is reasonable reduction and splint fixation.更多还原