经肘横纹前方入路治疗儿童Gartland Ⅲ型肱骨髁上骨折  

The anterior cubital approach for irreducible Gartland type Ill supracondylar fractures of the humerus in children

作　　者：徐宏文[1] 李旭[1] 刘佳[1] 陈伟东[1] 周庆和[1] 刘远忠[1] 

机构地区：[1]广州市儿童医院骨科,510120

出　　处：《中华创伤骨科杂志》2009年第9期805-808,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的对于闭合复位失败或合并前方血管神经卡压的儿童GartlandⅢ型肱骨髁上骨折，探讨经肘横纹前方入路克氏针内固定的治疗效果。方法自2005年4月至2008年3月对44例闭合复位失败或合并血管神经症状的儿童（2～11岁，平均4．6岁）GartlandⅢ型肱骨髁上骨折行开放复位，其中肘横纹前方入路19例，其他入路25例（外侧入路21例，内外侧联合入路4例）。术中复位满意后克氏针内固定辅以石膏托固定，3周后行功能锻炼。以肘关节Flynn等评分系统进行评估。结果所有患者平均随访1．8年（1～4年），经肘横纹前方入路组与其他入路组在提携角丢失及肘屈伸功能方面差异无统计学意义（肘横纹前方入路组优良率89％，其他入路组83％，P〉0．05）；肘横纹前方入路组的手术时间显著短于其他人路组，差异有统计学意义（P〈0．05）。结论经肘横纹前方入路治疗闭合复位失败或合并前方血管神经卡压的儿童Gartland Ⅲ型肱骨髁上骨折，便于安全快速地获得解剖复位，利于探查骨折伴发的血管神经损伤，是一种可供选择的手术入路。Objective To assess the anterior cubital fossa approach in the treatment of irreducible Gartland type m supracondylar fractures of the humerus in children. Methods Forty-four children （26 boys） with Gartland Ill supracondylar fractures of the humerus were divided into 2 groups. Group A（ 19 eases） was treated with a minimal incision in the anterior cubital fossa, and Group B （25 cases） through anterolateral cubital fossa or combined median-lateral approach. The fractures were stabilized with 1.5 mm Kirschner wires and plaster slab after anatomical reduction, followed by functional exercise for 3 to 6 weeks. The clinical outcomes of the 2 groups were evaluated by the Flynn score system for the elbow joint. Results All patients were followed up for 1 to 4 years, with an average of 1.8 years. Group A needed significantly shorter operation time （37 vs. 59 minutes）. The good to excellent rates were 89% for Group A and 83% for Group B. There was no significant difference in functional recovery between the 2 groups （ P 〉0. 05）. Conclusion Open reduction through the anterior cuhital approach is a quick and safe alternative for pediatric Gartland Ill supracondylar fractures of the humerus, because it allows good visualization of the median and ulnar nerves, the brachial artery and the fracture.

关 键 词：肱骨骨折 儿童 外科手术 

分 类 号：R686[医药卫生—骨科学]