儿童肱骨髁上骨折合并神经损伤的类型分布及神经营养药物应用价值的研究  

Distribution of different types of pediatric supracondylar humeral fractures with nerve-injury and the use of mecobalamin

作　　者：张国强[1] 杨建平[2] 

机构地区：[1]天津港口医院骨科,天津300456 [2]天津市天津医院小儿骨科,天津300211

出　　处：《中国矫形外科杂志》2012年第8期673-676,共4页Orthopedic Journal of China

摘　　要：[目的]探讨儿童肱骨髁上骨折合并神经损伤的类型分布规律,对比研究神经营养药物-甲钴胺的应用价值。[方法]对2006年1月～2010年8月天津市天津医院收治的740例完全移位的肱骨髁上骨折(GartlandⅢ型)患儿病案资料进行回顾性调查。调查骨折类型的分布及不同骨折类型发生神经损伤的概率,分析骨折类型与损伤神经种类的关系。随访伴发神经损伤患儿神经恢复时间,比较甲钴胺应用与否对神经损伤恢复时间的影响。[结果]740例患儿中病例和影像学资料完整的共678例,合并神经损伤共114例(16.8%),男孩骨折合并神经损伤比例20.3%,女孩骨折合并神经损伤比例11.5%。所有患儿均于伤后1～3 d施行闭合复位经皮穿针固定,所有损伤神经均获得恢复。应用甲钴胺组神经损伤恢复时间为(7.10±3.525)周,未用药组为(5.86±2.445)周。t检验P>0.05,无统计学差异。正中神经损伤恢复时间为(6.23±3.273)周,桡神经为(5.36±1.95)周,尺神经为(9.00±2.673)周,正中神经、桡神经神经功能恢复时间对比尺神经存在显著统计学差异。[结论]骨折的良好复位和稳定的固定、早期解除骨折断端对神经的压迫是神经损伤恢复的前提条件。闭合肱骨髁上骨折合并神经损伤早期不需要切开复位和神经探查,闭合复位经皮穿针固定可取得良好的复位和固定效果。尺神经恢复较桡神经及正中神经慢。甲钴胺的应用对缩短神经损伤恢复时间无明显的帮助。对于饮食正常的儿童肱骨髁上骨折合并神经损伤不需要常规应用甲钴铵治疗。[Objective]The purpose of this study was to estimate the correlation between fracture types and nerve injury and the value of mecobalamin. [ Method] A retrospective review was made in 740 children who received treatment for supracondylar fracture of the humerus in Tianjin hospital between January 2006 and August 2010. Relationship between fracture types and associated nerve injury was analyzed. Recovery time of ulnar, radial and median nerve injury were recorded. The effect of mecobalamin in the recovery of nerve injury was evaluated. [ Result ] Totally 678 of 740 children had complete records. Boys had a tendency toward nerve injury （20.3 % ：11.5 % ）. All patients received close reduction and percutaneous pinning. All never injuries recovered. The mean recovery time in the mecobalamin medication group was 7.10 ± 3. 525 weeks, compared with 5.86 ± 2. 445 weeks in the control group. There was no significant difference between groups （T test, P 〉 0.05 ）. Recovery time for median nerve, radial nerve and ulnar injury were 6.23 ± 3. 273 weeks, 5.36：1：1.95 weeks and 9.00 ± 2. 673, respectively. There was no statistic difference between median and radial nerve injuries, but there was a statistic difference between median and radial nerve injury compared with ulnar nerve injury in respect to recovery time. [ Conclusion] Good reduction and stable fixation provide a basis for nerve injury recovery. The closed frectures neednt open reduction and early neural probe. No significant im- provement was seen in the mecobalamin medication group in respect to nerve recovery after injury. There was a statistic differ- ence in different nerve injury recovery. Ulnar nerve had a longer recovery time compared with radial and median nerve.

关 键 词：儿童 肱骨髁上骨折 分型 神经损伤 药物 

分 类 号：R726.8[医药卫生—儿科]