尺神经沟置针治疗儿童GartlandⅢ型肱骨髁上骨折的生物力学试验及临床应用  

The biomechanical study and clinical application of internal fixation with Kirschner wire placed in the nerval fossa of ulna for GartlandⅢsupracondylar fractures of humerus in children

作　　者：朱亚中[1] 徐惠芬 陈金富[1] 冯炜[1] 卢一生[3] 王以进[4] 王春生[5] 

机构地区：[1]解放军第九十八医院骨科,湖州313000 [2]湖州中医院特诊科 [3]解放军第一一七医院骨科 [4]上海大学力学研究所 [5]湖州师范学院医学院卫生统计学教研室

出　　处：《中华创伤杂志》2006年第10期744-748,共5页Chinese Journal of Trauma

基　　金：湖州市科研基金(2005YS03)

摘　　要：目的进行生物力学试验,比较从肱骨内上髁至尺神经沟不同进针点与桡侧克氏针交叉固定治疗儿童GartlandⅢ型肱骨髁上骨折的稳定性,为临床减少肘内翻提供理论依据。方法将10具尸体20个肱骨标本制成肱骨髁上骨折模型,分A、B两组。A组：从肱骨内上髁至尺神经沟平分取5点向对侧某点打入克氏针与桡侧克氏针交叉固定；B组：以尺神经沟为始点向对侧5个不同方向打入克氏针与桡侧克氏针交叉固定。分别进行生物力学测定。临床治疗GartlandⅢ型肱骨髁上骨折患儿46例,随访1年以上。结果A组与B组一致,随着克氏针与骨折线成角越大,应变越小,位移变化越小,应力强度越大,轴向刚度越大,抗扭能力越强,其差异具有统计学意义(P＜0．05)。临床46例患者。肘关节功能良好,无肘内翻发生。结论儿童GartlandⅢ型肱骨髁上骨折骨折复位后将尺侧克氏针从肱骨内上髁移至尺神经沟与桡侧克氏针交叉固定,其生物力学稳定性增强,减少了肘内翻的发生。Objective To perform a biomechanical study on and compare the stability of internal fixation with closed Kirschner wire in different spots from the epicondylus medialis to sulcus nervi ulnaris and epicondylus lateralis of humerus in the treatment of Gartland Ⅲ supracondylar fractures of humerus in children in order to provide basis for avoiding cubitus varus in clinic. Methods Twenty models of supracondylar fractures were made from ten humerus samples, then divided into two groups （group A and group B）. They were fixed with closed Kirschner＇wires. Ulnar Kirschner wire varied. In group A five spots were selected averagely from the epicondylus medialis to the sulcus nervi ulnaris. Kirschner wires entered from one of the five spots into another spot of humerus. In group B Kirschner wires entered defferent spots of humerus from the central spot of sulcus nervi ulnaris. Biomechanical tests were carried out, such as axial load, axial displacement, stress intensity, axial rigidity and anti-twisty ability. Forty-six children with Gartland Ⅲ supracondylar fracture of humerus were treated and followed up for more than one year. Results In both groups, with the angle of Kirschner wires and fracture side increasing, the strain and the vertical displacement decreased, the stress intensity and the axial rigidity increased, and the anti-twists ability was enhanced. There was statistic difference （P 〈 0.05）. The follow-up of the 46 patients showed the elbow joint function recovered well with no cubitus varus malformation. Conclusion Internal fixation with closed Kirschner wires in sulcus nervi ulnaris from the epicondylus medialis and the epicondylus lateralis of humerus for Gartland Ⅲ supracondylar fracture of humerus in children has the advantages of enhancing biomechanical stability, effective prevention of secondary replacement of outlying black of the fracture and avoidance of cubitus varus. It can be widely used clinically.

关 键 词：肱骨骨折 儿童 骨折固定术 内 生物力学 尺神经沟 

分 类 号：R726.8[医药卫生—儿科]