[1]曹谦,曹慎,杨韵琴.GartlandⅢ型肱骨髁上骨折手法复位小夹板外固定治疗后残存单纯前后移位对预后的影响[J].中医正骨,2017,29(09):7-11.
　CAO Qian,CAO Shen,YANG Yunqin.Effect of posttreatment residual simple anterior-posterior displacement of broken end of fractured bone on prognosis in patients who receive manipulative reduction and small splint external fixation for Gartland typeⅢhumeral supracondylar fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(09):7-11.
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GartlandⅢ型肱骨髁上骨折手法复位小夹板外固定治疗后残存单纯前后移位对预后的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年09期
页码:
7-11
栏目:
临床研究
出版日期:
2017-09-20

文章信息/Info

Title:
Effect of posttreatment residual simple anterior-posterior displacement of broken end of fractured bone on prognosis in patients who receive manipulative reduction and small splint external fixation for Gartland typeⅢhumeral supracondylar fractures
作者:
曹谦; 曹慎; 杨韵琴
湖南省湘潭市中医医院,湖南 湘潭 411100
Author(s):
CAO Qian; CAO Shen; YANG Yunqin
Xiangtan Hospital of Traditional Chinese Medicine,Xiangtan 411100,Hunan,China
关键词:
肱骨骨折;  肘关节;  正骨手法;  预后;  儿童;  青少年;  骨折移位
Keywords:
Key words humeral fractures;  elbow joint;  bone setting manipulation;  prognosis;  child;  adolescent;  displacement fracture
摘要:
目的:探讨GartlandⅢ型肱骨髁上骨折手法复位小夹板外固定治疗后残存单纯前后移位对预后的影响。方法:收集2009年1月至2016年3月采用杨氏四步复位手法治疗后,残存断端前后移位的85例新鲜闭合GartlandⅢ型肱骨髁上骨折患者的病例资料。在治疗后肘关节侧位X线片上,将肱骨近端横径分成3等份,分别过2个等分点垂直于肱骨近端横径做垂线。按照移位方向将前后移位分为A型(向后移位)和B型(向前移位)2类,再分别按照远折端前缘和后缘相对于2条垂线的位置将其进一步分为AⅠ型(远折端前缘位于第1条垂线前方)、AⅡ型(远折端前缘位于2条垂线之间)、AⅢ型(远折端前缘位于第2条垂线后方)、BⅠ型(远折端后缘位于第2条垂线后方)、BⅡ型(远折端后缘位于2条垂线之间)、BⅢ型(远折端后缘位于第1条垂线前方)。记录患者的骨折愈合时间、治疗后即刻和治疗后12个月时的Baumann角,以及治疗后3个月和12个月采用Flynm标准评定的肘关节功能。结果:失访5例; 80例患者获得随访,随访时间12～24个月,中位数14个月。AⅠ型35例、AⅡ型18例、AⅢ型5例、BⅠ型11例、BⅡ型8例、BⅢ型3例。所有患者的骨折均在1个月内达到临床愈合标准,6种前后移位类型患者的骨折愈合时间比较,差异无统计学意义[(28.53±1.25)min,(29.01±1.19)min,(29.19±1.50)min,(28.91±1.30)min,(29.05±1.24)min,(29.31±1.17)min,F=0.420,P=0.671]。治疗后即刻及治疗后12个月时所有患者的Baumann角均在正常范围内,至随访结束时所有患者均未发生肘内翻; 治疗后即刻及治疗后12个月时6种前后移位类型患者的Baumann角比较,组间差异无统计学意义(74.04°±4.40°,73.09°±4.69°,73.01°±4.26°,72.98°±4.32°,73.14°±3.90°,72.93°±4.06°,F=0.263,P=0.792; 74.35°±4.38°,73.14°±5.08°,72.52°±4.45°,73.67°±3.98°,72.93°±3.97°,72.88°±3.96°,F=0.817,P=0.419)。治疗后3个月时按照Flynm标准评定肘关节功能,优32例(AⅠ型22例、AⅡ型4例、BⅠ型6例)、良18例(AⅠ型11例、AⅡ型2例、BⅠ型4例、BⅡ型1例)、可27例(AⅠ型2例、AⅡ型11例、AⅢ型4例、BⅠ型1例、BⅡ型7例、BⅢ型2例)、差3例(AⅡ型1例、AⅢ型1例、BⅢ型1例),残存AⅠ型、BⅠ型前后移位骨折患者的肘关节功能优于其他类型的残存骨折前后移位患者(R^-AⅠ型=27.07,R^-AⅡ型=51.78,R^-AⅢ型=67.00,R^-BⅠ型=29.91,R^-BⅡ型=61.19,R^-BⅢ型=69.00,χ2=40.132,P=0.000)。治疗后12个月时按照Flynm标准评定肘关节功能,优46例(AⅠ型28例、AⅡ型8例、BⅠ型7例、BⅡ型3例)、良34例(AⅠ型7例、AⅡ型10例、AⅢ型5例、BⅠ型4例、BⅡ型5例、BⅢ型3例),残存AⅠ型、BⅠ型前后移位骨折患者的肘关节功能优于其他类型的前后移位患者(R^-AⅠ型=31.50,R^-AⅡ型=45.72,R^-AⅢ型=63.50,R^-BⅠ型=38.05,R^-BⅡ型=48.50,R^-BⅢ型=63.50,χ2=20.548,P=0.001)。结论:GartlandⅢ型肱骨髁上骨折手法复位小夹板外固定治疗后残存的各种程度的单纯前后移位均不会影响骨折愈合和肘关节外观,但残存轻度前后移位患者比残存中重度前后移位患者的肘关节功能恢复好。
Abstract:
ABSTRACT Objective:To explore the effect of posttreatment residual simple anterior-posterior displacement of broken end of fractured bone on prognosis in patients who receive manipulative reduction and small splint external fixation for Gartland typeⅢhumeral supracondylar fractures.Methods:The medical records of 85 patients with residual anterior-posterior displacement of broken end of fractured bone after treatment of fresh closed Gartland typeⅢhumeral supracondylar fracture with Yang's four-step reduction manipulation from January 2009 to March 2016 were collected.The transverse diameter of proximal humerus was divided into 3 equal parts on the posttreatment lateral X-ray films of elbow joint.Two lines were drawn through the 2 equation points respectively and they crossed the transverse diameter of proximal humerus at right angles.The anterior-posterior displacement of broken end of fractured bone was divided into type A(retrodisplacement)and B(antedisplacement)based on the displacement direction,and was subdivided into type AⅠ(the anterior border of distal broken end was in front of the first perpendicular line),AⅡ(the anterior border of distal broken end was located between the 2 perpendicular lines),AⅢ(the anterior border of distal broken end was behind the second perpendicular line),BⅠ(the posterior border of distal broken end was behind the second perpendicular line),BⅡ(the posterior border of distal broken end was located between the 2 perpendicular lines)and BⅢ(the posterior border of distal broken end was in front of the first perpendicular line)based on the location of anterior border and posterior border of distal broken end relative to the 2 perpendicular lines respectively.Fracture healing time,Baumann angles measured immediately post-treatment and at 12 months after the treatment and the elbow joint function evaluated by using Flynm standard at 3 and 12 months after the treatment were recorded respectively.Results:Five patients lost to follow-up and eighty patients were followed up for 12-24 months with a median of 14 months.The anterior-posterior displacements belonged to types AⅠ(35),AⅡ(18),AⅢ(5),BⅠ(11),BⅡ(8)and BⅢ(3).All of the fractures got clinical healing within one month,and there was no statistical difference in the fracture healing time between the 6 types of anterior-posterior displacements(28.53+/-1.25,29.01+/-1.19,29.19+/-1.50,28.91+/-1.30,29.05+/-1.24,29.31+/-1.17 min,F=0.420,P=0.671).Baumann angles of all the patients measured immediately post-treatment and at 12 months after the treatment were within the normal range,and no cubitus varus was found in all the patients during the follow-up period.There was no statistical difference between the 6 types of anterior-posterior displacement in the Baumann angles measured immediately post-treatment and at 12 months after the treatment(74.04±+/-4.40,73.09+/-4.69,73.01+/-4.26,72.98+/-4.32,73.14+/-3.90,72.93+/-4.06,F=0.263,P=0.792; 74.35+/-4.38,73.14+/-5.08,72.52+/-4.45,73.67+/-3.98,72.93+/-3.97,72.88+/-3.96,F=0.817,P=0.419).The elbow joint functions were evaluated according to the Flynm standard at 3 months after the treatment.Thirty-two patients(22 type AⅠ,4 type AⅡand 6 type BⅠ)obtained an excellent result,18 good(11 type AⅠ,2 type AⅡ,4 type BⅠand 1 type BⅡ),27 fair(2 type AⅠ,11type AⅡ,4 type AⅢ,1 type BⅠ,7 type BⅡand 2 type BⅢ)and 3 poor(1 type AⅡ,1 type AⅢand 1 type BⅢ).The residual type AⅠand BⅠanterior-posterior displacement of broken end of fractured bone surpassed the other types in elbow joint function(R^-type AⅠ=27.07,R^-type AⅡ=51.78,R^-type AⅢ=67.00,R^-type BⅠ=29.91,R^-type BⅡ=61.19,R^-type BⅢ=69.00,χ2=40.132,P=0.000).The elbow joint functions were evaluated according to the Flynm standard at 12 months after the treatment.Forty-six patients(28 type AⅠ,8 type AⅡ,7 type BⅠand 3 type BⅡ)obtained an excellent result and 34 good(7 type AⅠ,10 type AⅡ,5 type AⅢ,4 type BⅠ,5 type BⅡand 3 type BⅢ).The residual type AⅠand BⅠanterior-posterior displacement of broken end of fractured bone surpassed the other types in elbow joint function(R^-type AⅠ=31.50,R^-type AⅡ=45.72,R^-type AⅢ=63.50,R^-type BⅠ=38.05,R^-type BⅡ=48.50,R^-type BⅢ=63.50,χ2=20.548,P=0.001).Conclusion:All types of posttreatment residual simple anterior-posterior displacement of broken end of fractured bone can not affect the fracture healing and the appearance of elbow joint of patients who receive manipulative reduction and small splint external fixation for Gartland typeⅢhumeral supracondylar fractures,while the patients with mild residual anterior-posterior displacement of broken end of fractured bone can get better recovery of elbow joint function compared to patients with moderate-to-severe residual anterior-posterior displacement.

参考文献/References:

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备注/Memo

备注/Memo:
基金项目:湖南省中医药科技计划项目(2015117); 湘潭市科技计划项目(SF-YB20161009) 通讯作者:曹谦 E-mail:172116099@qq.com
更新日期/Last Update: 2018-02-23