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[1]曹謙,曹慎,楊韻琴.GartlandⅢ型肱骨髁上骨折手法復(fù)位小夾板外固定治療后殘存單純前后移位對預(yù)后的影響[J].中醫(yī)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復(fù)位小夾板外固定治療后殘存單純前后移位對預(yù)后的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年09期
頁碼:
7-11
欄目:
臨床研究
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:
曹謙; 曹慎; 楊韻琴
湖南省湘潭市中醫(yī)醫(yī)院,湖南 湘潭 411100
Author(s):
CAO Qian; CAO Shen; YANG Yunqin
Xiangtan Hospital of Traditional Chinese Medicine,Xiangtan 411100,Hunan,China
關(guān)鍵詞:
肱骨骨折;  肘關(guān)節(jié);  正骨手法;  預(yù)后;  兒童;  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:探討GartlandⅢ型肱骨髁上骨折手法復(fù)位小夾板外固定治療后殘存單純前后移位對預(yù)后的影響。方法:收集2009年1月至2016年3月采用楊氏四步復(fù)位手法治療后,殘存斷端前后移位的85例新鮮閉合GartlandⅢ型肱骨髁上骨折患者的病例資料。在治療后肘關(guān)節(jié)側(cè)位X線片上,將肱骨近端橫徑分成3等份,分別過2個等分點(diǎn)垂直于肱骨近端橫徑做垂線。按照移位方向?qū)⑶昂笠莆环譃锳型(向后移位)和B型(向前移位)2類,再分別按照遠(yuǎn)折端前緣和后緣相對于2條垂線的位置將其進(jìn)一步分為AⅠ型(遠(yuǎn)折端前緣位于第1條垂線前方)、AⅡ型(遠(yuǎn)折端前緣位于2條垂線之間)、AⅢ型(遠(yuǎn)折端前緣位于第2條垂線后方)、BⅠ型(遠(yuǎn)折端后緣位于第2條垂線后方)、BⅡ型(遠(yuǎn)折端后緣位于2條垂線之間)、BⅢ型(遠(yuǎn)折端后緣位于第1條垂線前方)。記錄患者的骨折愈合時間、治療后即刻和治療后12個月時的Baumann角,以及治療后3個月和12個月采用Flynm標(biāo)準(zhǔn)評定的肘關(guān)節(jié)功能。結(jié)果:失訪5例; 80例患者獲得隨訪,隨訪時間12～24個月,中位數(shù)14個月。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個月內(nèi)達(dá)到臨床愈合標(biāo)準(zhǔn),6種前后移位類型患者的骨折愈合時間比較,差異無統(tǒng)計學(xué)意義[(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]。治療后即刻及治療后12個月時所有患者的Baumann角均在正常范圍內(nèi),至隨訪結(jié)束時所有患者均未發(fā)生肘內(nèi)翻; 治療后即刻及治療后12個月時6種前后移位類型患者的Baumann角比較,組間差異無統(tǒng)計學(xué)意義(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)。治療后3個月時按照Flynm標(biāo)準(zhǔn)評定肘關(guān)節(jié)功能,優(yōu)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),殘存AⅠ型、BⅠ型前后移位骨折患者的肘關(guān)節(jié)功能優(yōu)于其他類型的殘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)。治療后12個月時按照Flynm標(biāo)準(zhǔn)評定肘關(guān)節(jié)功能,優(yōu)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),殘存AⅠ型、BⅠ型前后移位骨折患者的肘關(guān)節(jié)功能優(yōu)于其他類型的前后移位患者(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)。結(jié)論:GartlandⅢ型肱骨髁上骨折手法復(fù)位小夾板外固定治療后殘存的各種程度的單純前后移位均不會影響骨折愈合和肘關(guān)節(jié)外觀,但殘存輕度前后移位患者比殘存中重度前后移位患者的肘關(guān)節(jié)功能恢復(fù)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.

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備注/Memo

備注/Memo:
基金項目:湖南省中醫(yī)藥科技計劃項目(2015117); 湘潭市科技計劃項目(SF-YB20161009) 通訊作者:曹謙 E-mail:[email protected]
更新日期/Last Update: 2018-02-23