| Objective: Supracondylar fracture of humerus is a common upper limb fracture in children.For patients with Gartland type Ⅲ humeral supracondylar fractures that failed to close and reduce,open reduction was performed.Children in the observation group were treated with open reduction and Bilateral Triceps Brachii Approach +intraoperative elbow release + postoperative rehabilitation treatment(no plaster).The children in the control group underwent :Internal fixation by triceps tongue-shaped flap to + postoperative rehabilitation(plaster).This study analyzes the follow-up data results of the two treatment modes to determine the anvantages and diadvantages,and aims to optimize clinical treatment and improve the treatment effect of the children.Methods: A Retrospective cohort study was used in this study.According to the perioperative treatment mode of the children in the observation group:open reduction and Bilateral Triceps Brachii Approach + intraoperative elbow release + postoperative rehabilitation treatment+ERAS(no plaster);Perioperative management of the children in the control group:Internal fixation by triceps tongue-shaped flap to + postoperative rehabilitation(plaster)(plaster fixation).For the data of the two groups of children who were followed up at 1,2,and 3 months after surgery,the difference in the recovery of joint function of the children was evaluated using the Mayo elbow score standard.Result:A total of 60 children with supracondylar fractures of the humerus were enrolled in this study.The observation group and the control group were 30 cases each,with an average age of(7.18 ± 1.78)years,41 males(68.33%)and 19 females(31.67%).There were 39(65.00%)cases on the left side and 21(35%)cases on the right side.There was no statistically significant difference between the observation group and the control group in terms of age,gender,and affected side(p> 0.05).According to the Mayo elbow crteria,analyze the elbow range of motion(ROM),the occurrence of elbow valgus deformity,pain,and affect daily life items,etc :1.Elbow joint range of motion(ROM)analysis: At 1,2,and 3 months after surgery,the differences between the observation group and the control group were statistically significant(p <0.01),and the elbow joint mobility of the observation group was greater than the control group.The elbow joint activity of the observationgroup and the control group were statistically different at different time points in each group(p <0.01).The postoperative elbow joint ROM of the two groups increased with time.2.Analysis of Cubitus varus There was no statistically significant difference in the incidence of Cubitus varus between the observation group and the control group within 1,2 and 3 months after surgery(p> 0.05).There was no significant difference in the incidence of Cubitus varus between the group and the control group at different time points in each group(p> 0.05).The incidence of Cubitus varus in the two groups of patients during postoperative follow-up records changed with time No significant changes.3.Analysis of items affected to daily activities: At 1 month after surgery,the difference between the number of items affected to daily activities of the two groups was statistically significant(p <0.01),and the degree of daily activities affected to the control group was greater than that of the observation group.4.Analysis of elbow pain: At 1,2,and 3 months after surgery,there was no statistically significant difference between the elbow pain grades of the observation group and the control group(p> 0.05),while the elbow joints of the observation group and the control group The difference of pain grade in each group at different time points was statistically significant(p <0.01).5.Analysis of surgical effect: According to the Mayo elbow crteria,the difference between the two groups of children with excellent scores and those with moderate to poor scores was statistically significant(p <0.05).Monthly showed that the recovery of elbow joint function in the observation group was better than that in the control group.The COX regression model was used to analyze the factors that may affect the postoperative effect.The results showed that only the operation method was the independent factor that affected the postoperative effect OR was(1.9295% CI:1.074-3.430),the postoperative effect of the observation group’s operation plan was better than that of the control group.6.Analysis of economics and hygiene : According to the comparison of economics and hygiene,it can be seen that the hospital stay of the observation group is 13(11-18)days shorter than that of the control group 18(14-20)days;the median of the total hospitalization cost of the observation group is 10755(9547-12482))Yuan is less than the total cost of hospitalization in the control group of 13304(10589-17454)Yuan.The incremental cost-effectiveness ratio of the observation group and the control group was-109%,that is,the healing effect of each additionalunit of the observation group was 109.26 yuan less than that of the control group.Conclusion:1.The elbow joint mobility of the observation group was better than that of the control group.2.The degree of recovery of elbow joints in the observation group is better than that in the control group.3.The hospital stay of the observation group was shorter than the control group,and the hospitalization cost of the observation group was less than that of the control group. |
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