手术时机对儿童肱骨髁上Gartland IIB、III型骨折预后的影响

Effect of Surgical Timing on Prognosis of Supracondylar Gartland IIB and Type III Fractures of Humerus in Children

摘要: 目的：研究手术时机对儿童肱骨髁上Gartland IIB、III型骨折预后的影响，并分析造成手术延迟的原因。方法：采用回顾性研究延安大学附属医院骨科儿童行手术治疗的肱骨髁上Gartland IIB、III型骨折患者96例，其中，12 h内手术者46例(<12 h组)，等于或超过12 h的50例(≥12 h组)。比较两组术后疗效，分析手术延迟的可能原因。统计两组患者的一般情况及手术时间、术中出血量、住院时间、骨折愈合时间、肘内翻、术后并发症及术后至末次随访Flynn肘关节疗效优良率比较(Flynn肘关节恢复评分标准)。结果：96例患儿均获随访，随访时间均为3~6个月，平均5个月。两组病例一般资料、骨折愈合时间、疗效优良率、肘内翻及术后并发症发生率比较差异无统计学意义(P > 0.05)，但<12 h组的手术时间、术中出血量、住院时间均优于≥12 h组(P < 0.05)。5例Gartland III型切开复位患儿术后出现尺神经麻痹，1~3个月恢复。术后骨折均骨性愈合，愈合时间2~3个月。≥12 h组中的50例患者中，非医疗原因造成的手术延迟有14例(28%)。结论：术前充分准备，早期手术对儿童肱骨髁上Gartland IIB、III型骨折患者可减少术中出血量、手术时间、住院时间，改善术后肘关节功能，减少并发症发生率。

Abstract: Objective: To study the effect of surgical timing on the prognosis of humeral supracondylar Gartland IIB and type III fractures in children, and to analyze the reasons for the delay in surgery. Methods: A retrospective study was conducted on 96 cases of children with supracondylar Gartland IIB and type III fractures of the humerus who underwent surgical treatment in the Department of Orthopedics of the Affiliated Hospital of Yan’an University. Among them, 46 cases (<12 h group) underwent surgery within 12 h, and 50 cases (≥12 h group) underwent surgery within 12 h or more. The postoperative efficacy of the two groups was compared to determine the possible reasons for the delay of surgery. The general situation, operative time, intraoperative blood loss, length of hospital stay, fracture healing time, cubitus varus, postoperative complications and the rate of efficacy of Flynn elbow joint from postoperative to the last follow-up were statistically compared between the two groups (Flynn elbow joint recovery score criteria). Results: All 96 children were followed up for 3 - 6 months, with an average of 5 months. There was no statistically significant difference between the two groups in general data, fracture healing time, excellent and good efficacy rate, cubitus varus and postoperative complication incidence (P > 0.05), but the operation time, intraoperative blood loss and hospitalization time of the <12 h group were all better than or greater than that of the ≥12 h group (P < 0.05). Ulnar nerve palsy occurred in 5 children with Gartland III open reduction after surgery, and recovered within 1 - 3 months. Postoperative fractures were all ossified, and the healing time was 2 - 3 months. Among the 50 patients in the group greater than or equal to 12 h, 14 patients (28%) had delayed surgery due to non-medical reasons. Conclusion: Adequate preoperative preparation, early operation on children with supracondylar Gartland IIB and type III fractures of the humerus can reduce intraoperative blood loss, operation time, hospitalization time, improve postoperative elbow joint function, and reduce the incidence of complications.