切开复位克氏针内固定＋石膏外固定治疗儿童Gartland Ⅲ型陈旧性肱骨髁上骨折  

Open reduction and internal fixation with K-wires ＋ plaster external fixation for old Gartland-Ⅲ supracondylar humeral fractures in children

作　　者：张文兵 刘星[1] 何金洲 李明[1] 罗聪[1] 曹豫江[1] 瞿向阳[1] Zhang Wenbing, Liu Xing, He Jinzhou, Li Ming, Luo Cong, Cao Yujiang, Qu Xiangyang.(Department of Orthopedics, Children＇s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, Chin)

机构地区：[1]重庆医科大学附属儿童医院骨一科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《中华创伤杂志》2018年第5期420-425,共6页Chinese Journal of Trauma

基　　金：重庆市卫生和计划生育委员会重点项目[渝卫科教（2013）39号2013-1-029];国家临床重点专科建设项目[国卫办医函（2013）544];重庆市科学技术委员会民生项目（cstc2016shmszxl30079）

摘　　要：目的 探讨切开复位克氏针内固定＋石膏外固定治疗儿童Gartland Ⅲ型陈旧性肱骨髁上骨折的临床疗效. 方法 采用回顾性病例系列研究分析2012年6月-2017年1月收治的49例儿童GartlandⅢ型陈旧性肱骨髁上骨折患者临床资料,其中男35例,女14例;年龄3.4～11.5岁,平均6.1岁.受伤至手术时间22 ～60 d,平均29.8 d.其中桡神经损伤5例,正中神经损伤1例,Volkmann缺血性肌挛缩1例.均采用切开复位克氏针内固定＋石膏外固定治疗.6例神经损伤患者行神经探查、松解,其中1例术中发现为神经部分断裂,行神经修复.随访观察骨折愈合及并发症情况;末次随访时,按照Flynn肘关节功能评价标准对患者行疗效评价;同时比较健侧与患侧肱骨纵轴长度、肱骨髁部横径,行肱骨生长发育评估. 结果 患者均获随访6～24个月,平均12.5个月.骨折均愈合,无骨折再移位和骨不连发生.6例神经损伤患者2个月后神经损伤症状基本消失.1例术后切口处浅表皮肤感染,对症处理好转.术后6例（12％）发生肘内翻畸形.末次随访时,按照Flynn肘关节功能评价标准：优37例,良5例,可1例,差6例;优良率86％.健侧与患侧的肱骨纵轴长度[（189.3 ±27.8） mm：（190.6 ±28.8）mm]及髁部横径[（29.5 ±3.5）mm：（29.7 ±3.6）mm]差异均无统计学意义（P＞0.05）. 结论 采用切开复位克氏针内固定＋石膏外固定治疗儿童GartlandⅢ型陈旧性肱骨髁上骨折,肘关节功能恢复满意,肘内翻发生率低,同时不影响患儿肱骨的生长发育,对临床有一定的指导意义.Objective To investigate the clinical efficacy of open reduction and internal fixation with K-wires for old Gartland Ⅲ supracondylar fracture in children.Methods A retrospective case series study was conducted on 49 children with old Gartland Ⅲ supracondylar humeral fracture admitted from June 2012 to January 2017.There were 35 boys and 14 girls,with average age of 6.1 years （range,3.4-11.5 years）.The duration from initial trauma to operation ranged from 22 days to 60 days （mean,29.8 days）.There were five cases of radial nerve injury,one case of median nerve injury,and one case of Volkmann ischemic contracture.All patients were surgically treated with open reduction and internal fixation with K-wires ＋ plaster external fixation.Six patients with nerve injury underwent neurological exploration and release.Nerve partial fracture was seen in one patient during operation,and nerve repair was performed.The fracture healing and complications were observed.At the final follow up,Flynn＇s criteria was applied to evaluate the elbow joint function.The humerus length and transverse diameter of humeral condyle between the healthy limb and the suffered one were compared to evaluate the humerus growth.Results All patients were followed up for 6-24 months,with an average of 12.5 months.All fractures were healed,with no fracture redisplacement or bone nonunion occurred.The neurological symptoms of six patients with nerve injury disappeared after two months.One patient had superficial skin infection at the incision and recovered after treatment.Six patients （12%） developed cubitus varus deformity after operation.At the final follow-up,the clinical and radiographic outcomes were assessed via Flynn＇s criteria,and the results were excellent in 37 patients,good in five,fair in one,and poor in six patients,with an excellent and good rate of 86%.There were no significant differences in the humerus length [（189.3 ± 27.8） mm vs.（190.6 ± 28.8） mm] and transverse diameter of humeral condylar [（29.5 ± 3.5�

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]