俯卧位闭合复位经皮克氏针内固定治疗儿童移位肱骨髁上骨折  

Closed reduction and percutaneous pin fixation of pediatric supracondylar humerus fractures in prone position

作　　者：魏俊强[1] 林静[1] 金宇[1] 赵景新[1] 王瑜[1] 孔令伟[1] 魏然[1] 

机构地区：[1]承德医学院附属医院创伤小儿骨科,河北承德067000

出　　处：《中国骨与关节损伤杂志》2016年第1期55-57,共3页Chinese Journal of Bone and Joint Injury

基　　金：河北省2014年度医学科学研究重点课题(ZD20140317)

摘　　要：目的 评价俯卧位闭合复位经皮克氏针内固定治疗儿童移位肱骨髁上骨折的疗效。方法 回顾性分析自2010-06—2013-05采用俯卧位闭合复位经皮克氏针内固定治疗的38例儿童移位肱骨髁上骨折。取俯卧位,患肢前臂悬垂于手术床边,在C型臂X线机透视下闭合复位肱骨髁上骨折满意后经皮从肱骨远端内外侧穿针固定。结果 本组手术时间35~118 min,平均70 min。所有患者均达到闭合复位。35例获得随访8~12个月,平均10个月。末次随访时35例骨折均愈合,无Volkman挛缩和肘内翻畸形,内侧穿针无医源性尺神经损伤。末次随访时患侧肘关节伸直-10°~4°,平均-4°;健侧肘关节伸直-14°~0°,平均-10°。患侧肘关节屈曲110°~140°,平均125°;健侧肘关节屈曲120°~150°,平均135°。同健侧相比,5例患侧丢失屈伸功能5°~10°,Flynn临床功能评定为良。患侧携带角0°~10°,平均7°;健侧携带角0°~15°,平均9°。3例患侧携带角丢失5°~10°,Flynn临床功能评定为良。患侧肘关节Baumann角变化值1°~6°,平均3.5°。结论俯卧位闭合复位经皮克氏针内固定治疗儿童移位肱骨髁上骨折具有复位容易,方便穿针和利于术中透视等优点。Objective To review the results of children displaced supracondylar humerus fractures with closed reduction and pereutaneous pin fixation in the prone position. Methods Thirty-eight patients were treated with closed reduction and pereutaneous Kirschner wire fixation between June 2010 and May 2013. All the children were in the prone position after general anesthesia. The Kirsehner wire was fixed from the distal humerus inside and outside after the fracture reduction in the C-arm fluoroscopy. Results Thirty five patients were followed up for 8-12 months, average 10 months. The operation time was 35-118 minutes, average 70 minutes. All of the fractures were treated with closed reduction. All eases achieved union at last follow up. There were no Volkman contracture, cubitus varus and iatrogenic ulnar nerve injury. At the last follow up, the injured elbow extension angle ranged from -10° to 4°, average -4°, the healthy elbow extension angle ranged from -14° to 0°, average -10% The injured elbow flexion angle ranged from 110° to 140°, average 125°, the healthy elbow flexion angle ranged from 120° to 150°, average 135°. Compared with the healthy elbow, 5 cases lost the elbow function of flexion-extension about 5°-10°, the Flynn clinical functional scores were good. The injured elbow carrying angle ranged from 0° to 10°, average 7°, the healthy elbow carrying angle ranged from 0° to 15° average 9°. Compared with the healthy elbow, 3 eases lost the carrying angle about 5°- 10°, the Flynn clinical functional scores were good. The Bauman angle＇s change value of the injured elbow was 1°-6°, average 3.5°Conclusion Closed reduction and percutaneous pin fixation of displaced pediatric supracondylar humerus fractures in the prone position is a good alternative. This technique could facilitate fracture reduction, safe pin placement and convenient fluoroscopy during operation.

关 键 词：移位肱骨髁上骨折 俯卧位 闭合复位 克氏针 内固定 儿童 

分 类 号：R687.3[医药卫生—骨科学]