闭合复位经皮穿针治疗儿童“不可复性”肱骨髁上骨折  

Closed reduction and percutaneous pinning in treatment of ＆quot;irreducible＆quot; supracondylar humerus fractures in children

作　　者：李旭[1] 史强[1] 吴伟平[1] 欧丽影 燕华[1] 金大地[1] 

机构地区：[1]南方医科大学第三附属医院广东省骨科研究院儿童骨科,510630

出　　处：《中华外科杂志》2015年第10期763-766,共4页Chinese Journal of Surgery

摘　　要：目的 探讨闭合复位经皮克氏针固定治疗儿童“不可复性”肱骨髁上骨折的临床疗效.方法 回顾性分析2011年7月至2013年7月南方医科大学第三附属医院儿童骨科收治的76例Garland Ⅲ型肱骨髁上骨折手术患儿的临床资料,其中男性52例,女性24例;年龄1.6 ～ 13岁,平均6.5岁;受伤至手术时间为4～48 h,平均6.8h.伸直型69例,屈曲型7例.高处坠落伤15例,运动摔伤61例.手术方案均选择闭合复位经皮穿针内固定.患儿术后定期随访行X线片检查,评估内容包括骨折愈合情况和肘关节功能.结果 76例患儿均获得随访,随访时间6 ～36个月,平均14个月.患儿均未出现骨筋膜室综合征、血管或神经受损等并发症.2例术前合并神经损伤的病例术后神经功能得以恢复.末次随访按Flynn功能评价标准评价肘关节功能,优71例,良5例.结论 对于GarlandⅢ型儿童肱骨髁上骨折,特别是“不可复性”肱骨髁上骨折,闭合复位穿针联合管型石膏固定可以获得良好复位,手术时间短,操作简单,术后可早期进行功能锻炼,促进肘关节功能的恢复.Objective To evaluate the clinical effects of closed reduction and percutaneous pinning in treatment of ＆quot; irreducible＆quot; supracondylar humeral fractures in children.Methods Seventy-six consecutive children of Gartland Ⅲ supracondylar humeral fractures treated in the Department of Pediatric Orthopedics of the Third Affiliated Hospital of Southern Medical University from July 2011 to July 2013 were analyzed retrospectively,of which 69 were extension type fractures and 7 were flexion type.There were 52 male and 24 female patients with an average age of 6.5 years （range 1.6 to 13 years）.The average time from injury to operation was 6.8 hours （range 4 to 48 hours）.The mechanism of injury included 15 cases of high falling,and 61 cases of falling to the ground while walking or running.All cases were treated via closed reduction and percutaneous pinning.The radiographs were assessed every follow-up,including the healing and function of the elbow.Results No major complications such as osteofascial compartment syndrome or neurovascular injuries occurred in these patients.Two cases with neurological injuries before the surgery were recovered fully after the surgery.According to Flynn criteria at follow-up evolution,71 cases were excellent,and 5 were good.Conclusions For the treatment of Gartland type Ⅲ supracondylar humerus fractures in children,including ＆quot;irreducible＆quot; supracondylar fractures of the humerus,closed reduction and percutaneous pinning is a safe and minimally invasive procedure,by which good fractures reductions and postoperative functions of the elbow can be achieved.

关 键 词：肱骨骨折 骨折固定术 内 儿童 

分 类 号：R726.8[医药卫生—儿科]