临床与病理杂志2023，Vol.43Issue(9)：1656-1663,8.DOI:10.11817/j.issn.2095-6959.2023.220084
冠状面移位方向对Gartland Ⅲ型儿童肱骨髁上骨折临床特征及预后的影响
Influence of coronal displacement direction on clinical characteristics and prognosis of supracondylar fracture of humerus in Gartland Ⅲ children
摘要
Abstract
Objective:To explore the impact of fracture line direction in the coronal profile on the clinical characteristics and prognosis of Gartland type Ⅲ pediatric supracondylar humeral fractures. Methods:The clinical data of 618 pediatric patients with Gartland type Ⅲ supracondylar humeral fractures,who admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from June 2019 to June 2022,were retrospectively analyzed.Based on radiological data,the patients were divided into Type Ⅲa(the distal fracture was displaced to the medial side)and Type Ⅲb(the distal fracture was displaced to the lateral side).Age,gender,affected side,neurovascular injury,operation time,fluoroscopy frequency,open reduction probability,Baumann Angle at the last follow-up,the number of cases with anterior humeral cortical line passing through the middle third of the ossification center of the capitellum under the lateral image were compared between the 2 types.The excellent and good rate of Flynn function evaluation was used to assess elbow joint function at 2 months postoperatively and the last follow-up. Results:There were 360 cases(58.25％)of Gartland type Ⅲa fractures,all of which were closed fractures,and 258 cases(41.75％)of Gartland type Ⅲb fractures,including 5 open fractures.There were no significant differences in age,gender or affected side between the 2 types of fractures(all P>0.05).Compared to the Tpye Ⅲa type fractures,Type IIIb fractures had a higher probability of neurovascular injury(1.92％vs 15.50％,P<0.05),require longer operation time[(20.30±5.05)vs(46.80±3.89)min,P<0.05],more frequent fluoroscopy(10.13±2.53 vs 26.13±3.67,P<0.05),and a higher probability of open reduction(0 vs 9.69％,P<0.05).At the last follow-up,the Baumann Angle for Type Ⅲa fractures was 80.33°±2.03°,and for Type Ⅲb fractures,it was 75.59°±1.89°,with a significant difference between the 2 types(P<0.05).On lateral imaging at the last follow-up,Type Ⅲb fractures had a higher proportion of the humeral anterior cortical line not passing through the middle one-third of the capitellum ossification center(2.78％vs 9.69％),with a significant defference between the 2 types(P<0.05).At 2 months postoperatively,the excellent and good rate of Flynn function evaluation for Type Ⅲa fractures was 89.44％,whereas for Type Ⅲb fractures,it was 39.53％,with a significant difference(P<0.05).Beyond 6 months postoperatively,at the last follow-up,the excellent and good rate of Flynn function evaluation for Type Ⅲa fractures was 98.32％,while Type Ⅲb fractures,it was 95.53％,with no significant difference(P>0.05). Conclusion:Different coronal displacement directions have a significant impact on the clinical characteristics and prognosis of Gartland type Ⅲ pediatric supracondylar humeral fractures.Gartland type Ⅲb fractures are associated with a higher probability of neurovascular injury,which is more difficult to treat,difficult to achieve anatomical reduction,has a higher rate of mild malunion,and requires longer rehabilitation time.关键词
儿童/Gartland Ⅲ型肱骨髁上骨折/骨折冠状面移位方向/临床特征/预后Key words
children/Gartland type Ⅲ supracondylar fracture of the humerus/fracture line direction in the coronal profile/clinical characteristics/prognosis引用本文复制引用
李永犇,李娜,宋效雷,赵彬..冠状面移位方向对Gartland Ⅲ型儿童肱骨髁上骨折临床特征及预后的影响[J].临床与病理杂志,2023,43(9):1656-1663,8.基金项目
沧州市科技计划自筹经费项目(213106067).This work was supported by Science and Technology Plan Self-financing Project of Cangzhou City,China(213106067). （213106067）
