儿童肱骨髁上骨折并发症分析  

RETROSPECTIVE ANALYSIS OF COMPLICATIONS OF SUPRACONDYLAR FRACTURE OF HUMERUS IN CHILDREN

作　　者：陈文瑶[1] 李新志[1] 郑之和[1] 曾勇[1] 孟琳[1] 张建华[1] 王宪伟[1] 于洋[1] 

机构地区：[1]三峡大学仁和医院骨科,湖北宜昌443001

出　　处：《中国修复重建外科杂志》2010年第3期315-318,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的分析儿童肱骨髁上骨折相关并发症发生原因及防治对策。方法2002年7月-2008年7月,收治203例儿童肱骨髁上骨折,回顾性分析49例出现并发症患儿的临床资料。男32例,女17例;年龄2～14岁,平均9岁。受伤原因:摔伤38例,高处坠落伤4例,交通伤7例。均为闭合骨折。伸直型44例,屈曲型5例。骨折根据Gartland分型标准:Ⅱ型10例,Ⅲ型39例。软组织轻度肿胀1例,中度28例,重度20例。单纯神经损伤10例,血管损伤21例,前臂骨筋膜室综合征3例。伤后至手术时间1～25d。其中13例行闭合复位,21例行闭合复位经皮克氏针固定,15例行切开复位克氏针内固定;骨折复位后均行肘关节屈曲90°位石膏托固定。其中2例血管损伤者取血栓后修复血管,2例热敷解痉;2例神经干挫伤肿胀者行神经外膜切开减压;骨筋膜室综合征者切开减压后7～10d二期缝合切口。结果术后切口均Ⅰ期愈合。患儿均获随访,随访时间1～5年,平均3.4年。骨折于4～8周达骨性愈合。血管损伤者血供均恢复正常。1例正中神经损伤者功能恢复不良,手术探查后仍遗留功能障碍。1例骨筋膜室综合征术后3个月发生Volkmann缺血性肌挛缩。术后3个月～1年发生肘内翻11例,骨化性肌炎4例。术后3个月按照Flynn临床功能评定标准评定肘关节功能:优21例,良7例,可3例,差18例。结论及时骨折复位是保证血管、神经功能恢复及预防骨筋膜室综合征的关键,保守治疗不能恢复者需手术探查;肘内翻的防治应贯穿于复位、固定以及功能康复的全过程。Abstract： Objective To investigate the causes and the measures for prevention and management of compl ications of supracondylar fracture of the humerus. Methods In 203 cases of supracondylar fracture of the humerus treated from July 2002 to July 2008, 49 cases had compl ication, whose data were retrospectively analyzed. There were 32 males and 17 females with an average age of 9 years（range 2-14 years）. Fracture was caused by tumble in 38 cases, by fall ing from height in 4 cases, and by traffic accident in 7 cases. All cases were closed fractures. According to Gartland typing for supracondylar fracture of the humerus, there were 10 cases of type II and 39 cases of type III. Compl ications included 21 cases of vascular injuries, 10 cases of neural injuries, and 3 cases of osteofascial compartment syndrome. The time from injury to operation was 1-25 days. Closed reduction was given in 13 cases, closed reduction plus percutaneous K-wire fixation in 21 cases, and open reduction plus K-wire fixation in 15 cases. After reduction, plaster external fixation was performed. The cases of manipulation which blood circulation could not improve underwent incision to exploration of blood vessel. Two cases of neural injuries were treated with incision decompression of epineurium. Three cases of osteofascial compartment syndrome were treated with incision decompression, and the incision was sutured after 7-10 days. Results All incisions healed by first intention. The duration of follow-up was 1-5 years with an average of 3.4 years. Fracture heal ing was achieved within 4-8 weeks. All vascular injuries and 9 cases of neural injures recovered thoroughly. Poor function occurred in 1 case of median nerve injury and Volkmann ischemic contracture in 1 case of osteofascial compartment syndrome. Cubitus varus deformity was found in 11 cases and myositis ossificans in 4 cases within 3 months to 1 year. According to Flynn standard of the function of elbow, the results were excellent in 21 cases, good in 7 cases, fair in 3 cases, p

关 键 词：肱骨髁上骨折 儿童 并发症 回顾分析 

分 类 号：R726.8[医药卫生—儿科]