Jiang Peng,Chen Wuping,Lin Hongwang,et al.Comparison of conservative and surgical treatment for Gartland type Ⅱ supracondylar humeral fracture in children[J].Journal of Clinical Pediatric Surgery,2021,20(07):646-651.[doi:10.12260/lcxewkzz.2021.07.010]
儿童Gartland Ⅱ型肱骨髁上骨折保守治疗和手术治疗的效果比较
- Title:
- Comparison of conservative and surgical treatment for Gartland type Ⅱ supracondylar humeral fracture in children
- Keywords:
- Humeral Fractures/SU; Supracondy larhumeral fractures; Gartlandtype Ⅱ; Fracture Fixation; Conservative Treatment; Treatment Outcome
- 分类号:
- R726.834.13;R687.3
- 摘要:
- 目的 比较保守治疗和手术治疗儿童Gartland Ⅱ型肱骨髁上骨折的效果。方法 回顾性分析2015年1月至2018年12月在海口市妇幼保健院接受治疗的41例Gartland Ⅱ型肱骨髁上骨折患者的临床资料，平均年龄（5.4±2.2）岁，根据治疗方式分为两组：保守治疗组（A组，17例）和手术治疗组（B组，24例）。两组患者年龄、性别、侧别以及术后随访时间均无显著差异。于末次随访时测量患侧肘关节的过伸角、屈曲角、屈伸活动范围（range of motion，ROM）、提携角。在X线正位片上测量Baumann角，并在侧位片上评价肱骨前缘连线是否通过肱骨小头的中1/3。采用上肢快速功能障碍量表对肘关节功能进行评分，根据Flynn肘关节临床功能评分标准评定疗效。结果 末次随访时，平均过伸角、屈曲角、ROM、提携角和Baumann角分别为（9.1±6.6）°、（139.2±6.7）°、（152±6.3）°、（8.4±5.9）°和（77.6±5.8）°。A、B两组的过伸角、屈曲角、ROM、提携角、Baumann角均无差异（P>0.05）。A组中有11例（64.7%）肱骨前缘连线通过肱骨小头中1/3（11例，64.7%），明显少于B组（22例，91.7%），差异有统计学意义（P=0.049）。末次随访时平均QuickDash评分为（1.5±2.1）分，两组QuickDash评分差异无统计学意义（t=0.750，P=0.458）。根据Flynn肘关节临床功能评分标准，A组优良率为94.1%（16/17），B组优良率为91.7%（22/24），差异无统计学意义（P>0.05）。A组有1例（5.9%）发生肘内翻；B组除1例（4.2%）发生肘内翻以外，1例（4.2%）发生尺神经损伤和1例（4.2%）出现针道感染。结论 对于儿童Gartland Ⅱ型肱骨髁上骨折，保守治疗和手术治疗均可以获得良好的外观和临床功能。手术治疗可以获得更好的影像学结果，而保守治疗的并发症发生率更低。
- Abstract:
- Objective To compare the outcomes of conservative treatment versus surgery for Gartland type Ⅱ supracondylar humeral fracture in children.Methods Retrospective review was conducted for clinical data of 41 children with Gartland type Ⅱ supracondylar humeral fracture from January 2015 to December 2018.Their mean age was (5.4±2.2) years.According to therapeutic modality,they were divided into two groups of conservative treatment (A,n=17) and surgery (B,n=24).No significant inter-group differences existed in age,gender,sideness or follow-up time.During the final follow-up visit,the elbow angles were measured,including hyperextension angle,flexion angle,range of motion (ROM) and clinical carrying angle.And Baumann angle was measured on anterior-posterior (AP) radiograph.Additionally,anterior humeral line (AHL),bisecting the middle third of humeral capitellum on lateral radiograph,was also evaluated.Function of elbow joint was scored by the Quick Disabilities of Arm,Shoulder and Elbow (QuickDASH) and the Flynn grading criteria of elbow clinical function.Results During the final follow-up visit,hyperextension angle,flexion angle,ROM,clinical carrying angle and Baumann angle were (9.1±6.6)°,(139.2±6.7)°,(152±6.3)°,(8.4±5.9)° and (77.6±5.8)° respectively.No significant inter-group differences existed in these angles.For 11 children in group A (64.7%),the line of AHL passed through the middle third of capitellum (n=11,64.7%) and it was significantly less than that in group B (n=22,91.7%) (P=0.049).The total QuickDASH score was (1.5±2.1) and there was no inter-group difference.According to the Flynn criteria,the rate of excellent & good was 94.1%(16/17) in group A and 91.7%(22/24) in group B.There was no inter-group difference.In group A,one child (n=1,5.9%) developed cubitus varus.In group B,there were the complications of cubitus varus (n=1,4.2%),ulnar nerve injury (n=1,4.2%) and pin tract infection (n=1,4.2%).Conclusion Both conservative treatment and surgery can achieve excellent cosmetic and clinical outcomes in children with Gartland type Ⅱ supracondylar humeral fractures.Surgery offers better radiographic outcomes while conservative treatment has a lower rate of complications.
参考文献/References:
1 Zorrilla SdNJ,Prada-Ca?izares A,Marti-Ciruelos R,et al.Supracondylar humeral fractures in children:current concepts for management and prognosis[J].Int Orthop,2015,39(11):2287-2296.DOI:10.1007/s00264-015-2975-4.
2 文玉伟,王强.儿童肱骨髁上骨折的诊疗进展[J].中华小儿外科杂志,2017,38(5):390-394.DOI:10.3760/cma.j.issn.0253-3006.2017.05.016. Wen YW,Wang Q.Recent advances in the diagnosis and treatment of supracondylar humeral fractures in children[J].Chin J Pediatr Surg,2017,38(5):390-394.DOI:10.3760/cma.j.issn.0253-3006.2017.05.016.
3 倪宏强.儿童肱骨髁上骨折的治疗进展[J].临床小儿外科杂志,2020,19(4):364-369,376.DOI:10.3969/j.issn.1671-6353.2020.04.016. Ni HQ.Therapeutic advances of supracondylar humeral fractures in children[J].J Clin Ped Sur,2020,19(4):364-369,376.DOI:10.3969/j.issn.1671-6353.2020.04.016.
4 王琪,郑志刚,马长生,等.闭合复位与改良闭合穿针治疗儿童肱骨髁上骨折324例疗效评价[J].临床小儿外科杂志,2010,9(2):134-135,137.DOI:10.3969/j.issn.1671-6353.2010.02.021. Wang Q,Zheng ZG,Ma CS,et al.Closed reduction and modified closed pinning in the treatment of supracondylar humeral fracture in 324 children[J].J Clin Ped Sur,2010,9(2):134-135,137.DOI:10.3969/j.issn.1671-6353.2010.02.021.
5 Ariyawatkul T,Eamsobhana P,Kaewpornsawan K.The necessity of fixation in Gartland type 2 supracondylar fracture of the distal humerus in children (modified Gartland type 2A and 2B)[J].J Pediatr Orthop B,2016,25(2):159-164.DOI:10.1097/bpb.0000000000000251.
6 余希临,徐扬,沈先涛,等.儿童Gartland Ⅱ型肱骨髁上骨折的手术治疗[J].中国矫形外科杂志,2011,19(2):103-105.DOI:10.3977/j.issn.1005-8478.2011.02.04. Yu XL,Xu Y,Shen XT,et al.Surgical treatment of Gartland type Ⅱ supracondylar humeral fracture[J].Orthopedic Journal Of China,2011,19(2):103-105.DOI:10.3977/j.issn.1005-8478.2011.02.04.
7 Roberts L,Strelzow J,Schaeffer EK,et al.Nonoperative treatment of type ⅡA supracondylar humerus fractures:comparing 2 modalities[J].J Pediatr Orthop,2018,38(10):521-526.DOI:10.1097/bpo.0000000000000863.
8 Iorio C,Crostelli M,Mazza O,et al.Conservative versus surgical treatment of Gartland type 2 supracondylar humeral fractures:What can help us choosing?[J].J Orthop,2019,16(1):31-35.DOI:10.1016/j.jor.2018.12.001.
9 Shenoy PM,Islam A,Puri R.Current management of paediatric supracondylar fractures of the humerus[J].Cureus,2020,12(5):e8137.DOI:10.7759/cureus.8137.
10 Leung S,Paryavi E,Herman MJ,et al.Does the modified Gartland classification clarify decision making?[J].J Pediatr Orthop,2018,38(1):22-26.DOI:10.1097/bpo.0000000000000741.
11 Heal J,Bould M,Livingstone J,et al.Reproducibility of the Gartland classification for supracondylar humeral fractures in children[J].J Orthop Surg (Hong Kong),2007,15(1):12-14.DOI:10.1177/230949900701500104.
12 Beaton DE,Wright JG,Katz JN.Development of the QuickDASH:comparison of three item-reduction approaches[J].J Bone Joint Surg Am,2005,87(5):1038-1046.DOI:10.2106/jbjs.d.02060.
13 Flynn JC,Matthews JG,Benoit RL.Blind pinning of displaced supracondylar fractures of the humerus in children.Sixteen years’ experience with long-term follow-up[J].J Bone Joint Surg Am,1974,56(2):263-272.
14 Williamson DM,Coates CJ,Miller RK,et al.Normal characteristics of the Baumann (humerocapitellar) angle:an aid in assessment of supracondylar fractures[J].J Pediatr Orthop,1992,12(5):636-639.
15 孔建中,史建靖,翁益民,等.Baumann角在儿童肱骨髁上骨折经皮固定术中的临床应用[J].中华小儿外科杂志,2005,26(5):249-252.DOI:10.3760/cma.j.issn.0253-3006.2005.05.009. Kong JZ,Shi JJ,Weng YM,et al.Clinical significance of Baumann’s angle during percutaneous pinning fixation for supracondylar humeral fractures in children[J].Chin J Pediatr Surg,2005,26(5):249-252.DOI:10.3760/cma.j.issn.0253-3006.2005.05.009.
16 Kao HK,Lee WC,Yang WE,et al.Clinical significance of anterior humeral line in supracondylar humeral fractures in children[J].Injury,2016,47(10):2252-2257.DOI:10.1016/j.injury.2016.06.037.
17 Mulpuri K,Hosalkar H,Howard A.AAOS clinical practice guideline:the treatment of pediatric supracondylar humerus fractures[J].J Am Acad Orthop Surg,2012,20(5):328-330.DOI:10.5435/jaaos-20-05-328.
18 Ojeaga P,Wyatt CW,Wilson P,et al.Pediatric type Ⅱ supracondylar humerus fractures:factors associated with successful closed reduction and immobilization[J].J Pediatr Orthop,2020,40(8):e690-e696.DOI:10.1097/bpo.0000000000001586.
19 Lucas DE,Willis LM,Klingele KE.Factors predictive of early radiographic failure after closed reduction of Gartland type Ⅱ supracondylar humeral fractures[J].J Orthop Tra-uma,2013,27(8):457-461.DOI:10.1097/BOT.0b013e31827aa78e.
20 Sinikumpu JJ,Pokka T,Sirvi M,et al.Gartland type Ⅱ supracondylar humerus fractures,their operative treatment and lateral pinning are increasing:a population-based epidemiologic study of extension-type supracondylar humerus fractures in children[J].Eur J Pediatr Surg,2017,27(5):455-461.DOI:10.1055/s-0036-1597270.
21 Camus T,MacLellan B,Cook PC,et al.Extension type Ⅱ pediatric supracondylar humerus fractures:a radiographic outcomes study of closed reduction and cast immobilization[J].J Pediatr Orthop,2011,31(4):366-371.DOI:10.1097/BPO.0b013e31821addcf.
22 Moraleda L,Valencia M,Barco R,et al.Natural history of unreduced Gartland type-Ⅱ supracondylar fractures of the humerus in children:a two to thirteen-year follow-up study[J].J Bone Joint Surg Am,2013,95(1):28-34.DOI:10.2106/jbjs.l.00132.
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备注/Memo
收稿日期:2020-12-05。
通讯作者:姜鹏,Email:3601128@qq.com