有限切开克氏针内固定治疗手法复位失败的儿童肱骨髁上骨折  

Limited open reduction and Kirschner wire internal fixation for the treatment of failed maneuver reposition of supracondylar fracture of humerus in children

作　　者：莫贤跃 吴东敏 蒋荣玉 

机构地区：[1]兴安界首骨伤医院骨8区,广西兴安541306

出　　处：《临床骨科杂志》2015年第3期358-360,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨儿童肱骨髁上骨折手法复位失败后采用肘外侧有限切开复位经皮内外侧3针交叉内固定治疗的方法及疗效。方法对19例麻醉下手法复位失败的儿童肱骨髁上骨折患者行肘外侧有限切开,去除影响复位因素后再次复位,C臂机监视下先在肱骨髁外侧用2枚克氏针平行或交叉固定,再伸直肘关节到50°位、保护尺神经下用1枚克氏针在内侧交叉固定,术后长臂石膏托固定于肘关节伸直70°位制动3周。结果19例均获随访,时间6~36个月。出现肘部前侧局限性骨化1例,肘关节周围弥散性骨化1例。按Flynn标准评定疗效：优13例,良3例,一般2例,差1例。结论肘外侧有限切开复位内外侧3针交叉固定治疗手法复位失败的儿童肱骨髁上骨折创伤小,疗效满意。Objective To investigate the method and curative effect of failed maneuver reposition of supracondylar fracture of humerus in children with lateral elbow limited open reduction and percutaneous bilateral three Kirschner wires cross fixation. Methods 19 cases of anesthesia manipulation replacement failure of supracondylar fracture of humerus in children patients were treated with lateral elbow limited open,removed the influence of reduction factors and reposited again,under the C-arm machine surveillance. First,lateral humeral condyle with 2 Kirschner wires parallel or cross fixation,and elbows were flexed to 50 degrees,under the protection of ulnar nerve,1 Kirschner wire was inserted from medial side for cross fixation. Long arm plaster immobilization was used in extension position elbow70 degrees of brake 3 weeks postoperatively. Results 19 cases were followed up for 6 ~ 36 months： 1 case with elbow front limitations of ossification,1 case of diffuse ossification around the elbow joint. According to the Flynn standard assessment of efficacy： excellent in 13 cases,good in 3,general in 2 and poor in 1. Conclusions Lateral elbow limited open reduction and internal and external side three Kirschner wires cross fixation for the treatment of failed maneuver reposition of supracondylar fracture of humerus in children has minimal trauma and gets satisfactory curative effect.

关 键 词：儿童 肱骨髁上骨折 骨折固定术 内 肘外侧入路 克氏针 

分 类 号：R683.41[医药卫生—骨科学] R687.32[医药卫生—外科学]