临床小儿外科杂志

目的探讨Gartland Ⅲ型肱骨髁上骨折后8 h内急诊简单复位骨折对于手术的影响。方法回顾性分析2010年1月至2013年5月间由本院收治的120例Gartland Ⅲ型肱骨髁上骨折患儿临床资料,均为伸直型,依据手术方式分为:闭合复位经皮克氏针内固定组(A组),切开复位克氏针内固定组(B组)。分析两组患儿是否在骨折后8 h内进行简单骨折复位处理的骨折闭合率和手术时间。结果骨折后8 h内急诊简单复位骨折的患者共70例,其中采用闭合复位经皮克氏针内固定术者66例,平均手术耗时(30.83± 16)min,因闭合复位失败而选择切开复位克氏针内固定术者4例,平均手术耗时(4 00± 83)min; 8 h内未简单复位骨折的患者共50例,其中采用闭合复位经皮克氏针内固定术者24例,平均手术时耗时(3 92± 70)min,因闭合复位失败而选择切开复位克氏针内固定术者26例,平均手术时耗时(60.12± 14)min; 骨折8 h内早期简单复位者的闭合复位手术成功率较骨折后未早期简单复位者显著提高(P<0.05),无论采取何种术式,骨折8 h内早期简单复位均可显著缩短手术耗时(P<0.05)。即骨折8 h内早期简单复位可显著提高闭合复位克氏针内固定术的成功率,且缩短手术所耗时间; 无论术式采用切开复位或者闭合复位,患者预后肘关节功能比较,差异无统计学意义(χ2= 460,P=0.483),肘关节功能恢复均较满意。结论小儿Gartland Ⅲ型肱骨髁上骨折后8 h内给予骨折简单复位,闭合复位手术成功率显著提高,是降低切开复位术式的有效措施之一; 无论采取何种术式,8 h内早期进行简单骨折复位均可显著缩短手术耗时。

Objective To explore the effect of simple reduction of emergency fracture on the operation of Gartland Ⅲ type supracondylar humeral fracture within 8 hours. Methods Retrospective analysis was performed for 120 cases of Gartland type Ⅲ supracondylar humeral fracture from January 2010 to May 201 According to surgical approaches,they were divided into closed reduction of Kirschner wire fixation group(group A)and Kirschner wire fixation group(group B). Fracture closure rate and operative duration of two groups were analyzed for simple fracture reduction within 8 hours after fracture. Results A total of 70 patients underwent simple reduction within 8 hours after fracture. And closed reduction and percutaneous Kirschner wire fixation was performed in 66 patients.The average operative duration was 30.83± 16 min. There were 4 cases of internal fixation and the average operative duration was 4 00± 83 min. A total of 50 patients underwent simple reduction of fractures beyond 8 hours while 24 patients had closed reduction and percutaneous Kirschner wire fixation. The average operative duration was 3 92± 70 min. Because of failed closed reduction,open reduction with wire fixation was peformed in 26 cases. The average operative duration was 60.12± 14 min. The success rate of closed reduction within 8 hours of early simple reduction was significantly higher than that of simple reduction after early fracture(P <0.05). No matter what type of procedure was used,simple reduction of early 8 hours of fracture could significantly shorten operative duration(P <0.05). Early reduction within 8 hours of fracture could significantly improve the success rate of closed reduction with Kirschner wire fixation and shorten operative duration; regardless of open reduction or closed reduction,patients with elbow function comparison( χ2= 460,P=0.483),recovery of elbow function were satisfactory. Conclusion Pediatric Gartland type Ⅲ supracondylar humeral fracture may achieve simple reduction of fractures.The success rate of closed resuscitation surgery is 9 3%. No matter what kind of surgery,8 hours early Simple fracture reduction can significantly reduce operative duration.

引言
1 材料与方法
2 结果
3 讨论

$表1 骨折早期处理对不同手术方式治疗成功率的影响[n(%)]<br/>Table 1 Effect of early treatment of fracture on success rate of different surgical methods$

表1 骨折早期处理对不同手术方式治疗成功率的影响[n(%)]
Table 1 Effect of early treatment of fracture on success rate of different surgical methods

表2 骨折早期处理对不同手术方式所耗时间的影响(x^-±s)<br/>Table 2 Effect of early treatment on operative durations of different surgical methods(x^-±s)

表2 骨折早期处理对不同手术方式所耗时间的影响(x^-±s)
Table 2 Effect of early treatment on operative durations of different surgical methods(x^-±s)

表3 两种手术方式Flynn标准评定对比[n(%)]<br/>Table 3 Comparison of two surgical methods for Flynn criteria[n(%)]

表3 两种手术方式Flynn标准评定对比[n(%)]
Table 3 Comparison of two surgical methods for Flynn criteria[n(%)]

$图1 术前正侧位x线; 图2术后正侧位x线; 图3Gartland Ⅲ型肱骨髁上骨折延迟复位; 图4Gartland Ⅲ型肱骨髁上骨折早期复位<br/>Fig.1 Preoperative lateral radiograph; Fig. 2 Postoperative lateral radiograph; Fig. 3 Delayed reduction of Gartland type Ⅲ humeral supracondylar fracture; Fig. 4 Surgical reduction of Gartland type Ⅲ supracondylar humeral fracture$

图1 术前正侧位x线; 图2术后正侧位x线; 图3Gartland Ⅲ型肱骨髁上骨折延迟复位; 图4Gartland Ⅲ型肱骨髁上骨折早期复位
Fig.1 Preoperative lateral radiograph; Fig. 2 Postoperative lateral radiograph; Fig. 3 Delayed reduction of Gartland type Ⅲ humeral supracondylar fracture; Fig. 4 Surgical reduction of Gartland type Ⅲ supracondylar humeral fracture

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备注

引言

1 材料与方法

2 结果

3 讨论

期刊信息

备注

引言

1 材料与方法

2 结 果

3 讨 论

期刊信息

2 结果

3 讨论