石膏或夹板外固定治疗移位肱骨髁上骨折近期临床疗效分析  

Treatment of displaced humeral supracondylar fractures in children with external fixation using plaster or splint

作　　者：谭平先 叶淦湖 任绍东 侯之启[2] 周国新 屠永刚 谭颖 周植森 

机构地区：[1]常平医院骨科,广东东莞523573 [2]广州市第一人民医院关节外科

出　　处：《中国骨伤》2011年第8期667-671,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨手法复位石膏或夹板外固定治疗Gartland Ⅱ、Ⅲ型肱骨髁上骨折的临床疗效。方法:回顾性分析2007年3月至2009年9月应用手法复位石膏或夹板外固定治疗Gartland Ⅱ、Ⅲ型肱骨髁上骨折的病例资料,其中男18例,女15例;年龄3～12岁,平均6.4岁。骨折均为伸直型,Gartland Ⅱ型21例,Ⅲ型12例。分析术前、术后X线片,对肘关节功能进行Flynn肱骨髁上骨折分级评定,记录并发症的发生情况。结果:33例均获随访,时间3～12个月,平均6.8个月。33例均手法复位成功,14例有肘关节周围不同程度的张力性水疱,9例由于张力性水疱影响石膏或夹板外固定发生骨折再次移位,5例择期静脉麻醉下行闭合复位克氏针内固定,4例行尺骨鹰嘴骨牵引治疗。患儿最后一次随访时Flynn肱骨髁上骨折评定分级:优11例,良16例,一般4例,差2例。结论:手法复位石膏或夹板外固定仍是治疗肱骨髁上骨折的重要方法,肘关节过度屈曲位固定虽然可以提供骨折断端较稳定的固定,但一定要密切观察患肢远端血运及肘关节周围皮肤情况,及时调整治疗策略预防并发症。Objective：To investigate the therapeutic effects of closed reduction and external fixation（plaster or splint） for the treatment of displaced humeral supracondylar fractures in children.Methods：From March 2007 to September 2009,33 children（15 female and 18 male） with humeral supracondylar fractures treated in our hospital,ranging from 3 to 12 years old with an average of 6.4 years old.All the fractures were extension-type injuries,the flexion injures were excluded in our study.The humeral supracondylar fractures were classified according to Gartland classification.There were 21 TypeⅡand 12 type Ⅲ.In the initial treatment,all the patients were treated with closed reduction and external immobilization.The blood supply of the damaged upper extremity was evaluated before and after treatment.Clinical assessment was obtained at final follow-up using Flynn criteria,and radiologic assessment was obtained using Baumann and lateral humerocapitellar angles.Results：All the children were treated successfully with closed reduction in the initial time;24 children maintained limb alignment by external immobilization.Nine patients lost position due to the swelling around the elbow which affected unstable external fixation during the follow-up,5 of which were treated with a repeated closed reduction and internal fixation with Kirschner wires,4 of which were treated with traction.Thirty-one patients had a satisfactory outcome and 2 patients had an unsatisfactory outcome according to the Flynn criteria at the latest follows-up.Conclusion：Closed reduction and external stabilization is an important method for the treatment of displaced humeral supracondylar fractures in children.Making regular follow-up visits after closed reduction and casting is important for patients to maintain acceptable alignment,avoid complications and diagnose any loss of reduction.

关 键 词：肱骨骨折 手法 骨科 石膏 外科 小夹板固定 

分 类 号：R683.41[医药卫生—骨科学]