探讨孤独症谱系障碍(ASD)儿童罹患无移位肱骨髁上骨折后的功能锻炼方法。

回顾2015年1月至2018年12月在中山大学附属第三医院儿童发育行为中心诊断为ASD的患儿。纳入标准：采用石膏托外固定治疗的3～7岁患儿，随访时间不少于6个月。排除标准：有其他部位骨折、保守治疗失败、既往已有患侧上肢活动受限、症状性ASD、其它先天性发育异常疾病。共纳入22名患儿，根据患儿是否采用针对性骨折功能锻炼方案，分为ASD功能锻炼组(15例)、ASD未功能锻炼组(7例)，并以发生同样骨折的正常发育儿童44名为非ASD儿童组。采用卡方检验比较3组患儿伤后2个月、6个月肘关节、尺桡关节的被动关节活动度(PROM)。并采用秩和检验比较ASD患儿生活自理能力变化。

ASD未功能锻炼组受伤后2个月的肘关节屈曲(F＝5.974，P<0.05)、伸展(F＝26.968，P<0.05)、尺桡关节旋转(旋前F＝5.162，P<0.05；旋后(F＝30.432，P<0.05)PROM均比另外2组儿童差；其伤后6个月在肘关节伸展(F＝12.318，P<0.05)和尺桡关节旋后(F＝24.504，P<0.05)功能仍明显比另2组儿童差。伤后6个月，ASD未功能锻炼组患儿的生活自理能力明显倒退(Z＝－2.225，P<0.05)。

保守治疗的无移位肱骨髁上骨折ASD儿童，宜进行骨折功能锻炼，有助于改善关节活动度，避免生活自理能力倒退。

To explore the functional exercise methods of children with autism spectrum disorder (ASD) after a non-displaced supracondylar fracture of the humerus.

Inclusion criteria: three to seven years old children treated with plaster external fixation who were followed up for not less than six months. Exclusion criteria: combined with other fractures, failure to adopt a conservative treatment, previous ipsilateral upper limb activity limitation, symptomatic ASD children, other congenital diseases. A total of 22 children diagnosed as ASD at the Children Development and Behavior Center in the Third Affiliated Hospital of Sun Yat-Sen University from January 2015 to December 2018 were included and then divided into functional exercise ASD group (15 cases), non-functional exercise ASD group (seven cases) . Normal developmental children (44 cases) with the same type of fracture were set as non-ASD children group. Chi-square test was used to compare the passive range of motion (PROM) of the elbow joint and the ankle joint at two months and six months after fracture in the three groups. For the changes in self-care ability of children with ASD, the rank sum test was used for comparison.

In the non-functional exercise ASD group, the flexion(F=5.974, P<0.05) and extension(F=26.968, P<0.05) of the elbow joint, and the rotation of the radio-ulnar joint (pronation F=5.162, P<0.05; supination F=30.432, P<0.05) were significantly worse than those of the other two groups at two months after the fracture. The elbow joint extension (F=12.318, P<0.05) and the radioulnar joint external rotation(F=24.504, P<0.05) at six months after the injury were still worse in the non-functional exercise group. The self-care ability of the non-functional exercise ASD group showed significantly retrogression at six months (Z=-2.225, P<0.05).

Functional training of fracture should be carried out in conservative treatment of non-displaced humeral supracondylar fractures in ASD children, which can help improve joint mobility and prevent self-care ability from regressing.