目的 比较儿童肱骨外髁骨折采用切开与闭合复位内固定两种手术方法的治疗效果。方法 42例儿童肱骨外髁骨折,其中MilchⅠ型5例,Ⅱ型37例。22例采用经肘关节外侧入路行切开复位及克氏针固定(切开组);20例采用闭合复位及克氏针固定(闭合组)。结果 切开组优20例,良2例;闭合组中优12例,良8例。提携角改变:切开组2例(9.1%)提携角比对侧增大10°,闭合组5例(25%)比对侧增大10°;肘关节伸屈:切开组1例(4.5%)伸屈肘范围比对侧减少10°,闭合组6例(30%);肱骨外髁隆起:切开组3例(13.5%)出现肱骨外髁隆起,闭合组9例(45%)。以上指标两组比较均有统计学差异(P<0.05)。结论 儿童肱骨外髁骨折采用切开复位内固定较闭合复位内固定效果更佳,并发症更少。

Objective To study the clinical effects of open reduction internal fixation on treatment of and closed reduction internal fixation of lateral condyle fractures of the humerus in children. Methods We prospectively studied 42 patients. According to appearance of the fracture line on X-rays ,there were 37 cases of type II and 5 cases of type 1 according to Milch classification system. In 22 fractures, we performed open reduction and percutaneous pin fixation; in 20, we used closed reduction and percutaneous pin fixation. Results According to the criteria of Hardare et al, clinical outcomes in the group with open reduction and percutaneous pin fixation were excellent in 20 patients, good in two patients and poor in none. Clinical outcomes in the group with closed reduction and percutaneous pin fixation were excellent in 12 patients, good in eight patients and poor in none. The difference in clinical outcome between the two groups was statistically significant (P<0.05). Two (9.1%) patient with open reduction and five (25%) patients with closed reduction had an increasing of 10? in their carrying angles, compared with the other side (P<0.05). One (4.5%) patient with open reduction and six (30%) patients with closed reduction had a lack of 10皁f extension of the elbow,compared with the other side. There was a statistically significant difference between the two groups in the lack of 10? of extension of the elbow (P<0.05). Lateral condylar carina deformity occurred in 3 (13.5%) patients with open reduction and 9 (45%) patients with closed reduction. The difference in lateral condylar carina deformity between the two groups was statistically significant (P<0.05). Conclusions Open reduction internal fixation is more effective than closed reduction internal fixation of lateral condyle fractures of the humerus in children, and there are few complications in open reduction internal fixation.