儿童肱骨髁上骨折合并肱动脉损伤的临床诊治分析  

Analysis of the clinical diagnosis and treatment of humeral supracondylar fracture with brachial artery injury in children

作　　者：刘鹏[1] 朱澍 刘列[1] 肖文兴[1] 宋宁亚[1] 公伟[1] LIU Peng;ZHU Shu;LIU Lie;XIAO Wenjie;SONG Ningya;GONG Wei(Department of Orthopedics,Baoji Central Hospital,Shaanxi Province,Baoji 721008,China;Department of Orthopedics,Air Force General Hospital,Beijing 100142,China)

机构地区：[1]陕西省宝鸡市中心医院骨科,陕西宝鸡721008 [2]空军总医院骨科,北京100142

出　　处：《中国医药导报》2019年第27期81-84,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(81802168)

摘　　要：目的探讨儿童GartlandⅢ肱骨髁上骨折合并肱动脉损伤的临床诊治经验。方法选择2016年8月~2018年8月陕西省宝鸡市中心医院收治的52例GartlandⅢ型肱骨髁上骨折合并肱动脉损伤的患儿,其中闭合性骨折患儿40例和开放性骨折患儿12例,前者采用肘外侧入路方式,首先对骨折进行复位固定,然后局部热敷,最后局部注射药物罂粟碱;后者先进行清创,然后上下延长创口,游离肱动脉断端并吻合,对骨折进行复位固定,最后用2~3枚克氏针进行交叉固定。比较两组患儿的治疗效果,采用Logistic回归分析患儿康复的影响因素。结果52例骨折患儿均愈合良好,肘关节活动功能恢复优良率为100%,均未发生相关并发症。Logistic回归分析结果示,肱骨髁上骨折患儿术后功能恢复的影响因素包括受伤至手术时间>48h、术后功能锻炼时间延迟及出院后遵医嘱依从性低(P<0.05)。结论影响肱骨髁上骨折患儿术后功能恢复的主要因素包括受伤至手术时间、术后功能锻炼时间以及出院后遵医嘱依从性。对可疑有血管损伤者,应仔细连续动态观察,一旦确诊,应尽早手术。Objective To explore the clinical experience of diagnosis and treatment of Gartland Ⅲ on the humerus condyle fracture merge brachial artery injuries in children. Methods From August 2016 to August 2018, 52 cases of Gartland type Ⅲ humerus condyle fracture merge brachial artery injury of children admitted in Baoji Central Hospital in Shaanxi Province were selected. These included 40 children with closed fractures and 12 children with open fractures. The former adopted the method of lateral approach of elbow, the fracture was fixed first, then local hot compress was done, and finally local injection of Papaverine. The latter first debridement, then upper and lower extension of the wound, the broken end of brachial artery was freed, anastomosis, and then fracture reduction and fixation were carried out. Finally with 2-3 kirschner wire cross fixation. The treatment effects of children of the two groups were compared, and Logistic regression analysis was used to analyze the factors affecting the recovery of the children. Results All the 52 cases of fracture healed well, and the recovery rate of elbow joint motion function was 100%. No related complications occurred in the two groups. Logistic multivariate regression analysis showed that the factors affecting the postoperative functional recovery of children with humeral supracondylar fracture included injury to operation time> 48 h, postoperative functional exercise time delay and low compliance with medical advice after discharge (P < 0.05). Conclusion The main factors affecting the postoperative functional recovery of children with supracondylar fracture of humerus included injury to operation time, postoperative functional exercise time and discharge compliance. Patients with suspected vascular injury should be carefully continuous dynamic observated, early surgical treatment should be adopt once diagnosed.

关 键 词：肱骨髁上骨折 血管损伤 切开复位 内固定 

分 类 号：R726.8[医药卫生—儿科]