彩超辅助下治疗儿童GartlandⅢ型肱骨髁上骨折并血管损伤的疗效  

Analysis of curative effect of Doppler ultrasound-guided management for vascular complications of Gartland type Ⅲ supracondylar fractures of the humerus in children

作　　者：伍兴[1] 李雄涛[1] 夏敬冬[1] 陈小亮[1] 周治国[1] 张平[1] 沈先涛[1] Wu Xing;Li Xiongtao;Xia Jingdong;Chen Xiaoliang;Zhou Zhiguo;Zhang Ping;Shen Xiantao(Department of Pediatric Orthopedic Surgery,Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院骨科,武汉430016

出　　处：《中华实用儿科临床杂志》2020年第11期856-859,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：武汉市卫计委科研项目(WX14C49);湖北省自然科学基金(2013CKB026)。

摘　　要：目的:探讨彩超辅助下治疗儿童GartlandⅢ型肱骨髁上骨折并血管损伤的疗效。方法:前瞻性分析2017年3月至2018年3月武汉儿童医院骨科收治的18例儿童闭合性GartlandⅢ型肱骨髁上骨折并血管损伤的病历资料,其中男12例,女6例;年龄2.1~8.6岁,平均4.4岁;左侧10例,右侧8例。患儿均在伤后24 h内闭合复位内固定术,术中先行彩超判断肱动脉的走形,确定骨折断端与肱动脉的关系,术后彩超判断肱动脉搏动及血管内血流。按照桡动脉搏动及末梢血运评估肱动脉,Flynn评分及Mayo肘关节评分评定肘关节功能。结果:18例患儿术后获6~12个月(平均9个月)随访。复位前,18例患肢桡动脉搏动消失,末梢血运循环良好。18例患肢彩超探查见肱动脉位于肱骨近端骨折块前方,近端可及血流搏动,远端血管受压,连续性中断,其中13例患肢彩超未探查到桡动脉内血流;5例彩超探查到桡动脉内血流及搏动。所有患肢骨折复位后的末梢血运循环好,其中1例复位后,术中观察5 min,末梢血运循环恢复。其中14例患儿复位后,桡动脉搏动均恢复。4例患儿复位后,桡动脉搏动未恢复而末梢血运循环良好,术中彩超提示肱动脉内血流通畅,术后3~5周桡动脉搏动均恢复。并神经损伤的5例患儿术后12~24周(平均16周)神经损伤恢复。无前臂筋膜间室综合征和肘关节功能障碍等并发症发生。按照Flynn评分标准评定:优12例,良6例,优良率为100%。按Mayo肘关节评分:优17例,良1例,优良率为100%。结论:彩超引导下治疗儿童闭合性GartlandⅢ型肱骨髁上骨折并血管神经损伤,可作为首选的治疗方法之一。Objective To investigate the curative effect of Doppler ultrasound-guided management of vascular injury of Gartland typeⅢsupracondylar fractures of humerus in children.Methods A prospective study on 18 children with vascular complications of pulseless Gartland typeⅢsupracondylar humeral fracture who were admitted at Department of Pediatric Orthopedic Surgery,Wuhan Children′s Hospital from March 2017 to March 2018 was conducted.Among these children,12 were male and 6 were female,with the age of 2.1-8.6 years(mean 4.4 years old),and 10 cases were injured on the left and 8 cases on the right.All patients were satisfied with closed reduction and internal fixation within 24 hours after injury.Before the operation,Doppler ultrasound was performed to determine the shape of brachial artery and it relationship with fracture.During reduction,Doppler ultrasound was used to assess brachial pulse and blood perfusion.Then,the brachial artery was assessed by palpable radial pulse and peripheral blood supply,and elbow joint function was evaluated with Mayo Elbow Performance Score and Flynn criteria.Results Eighteen patients were followed up for 6 to 12 months(average 9 months)after operation.Before reduction,radial pulse disappeared and peripheral blood supply was good in 18 cases.Preoperative Doppler ultrasonography showed that the brachial artery was located in front of the proximal humerus fracture fragment.A proximal stream of the brachial artery was identified,but the distal blood vessels were compressed by the fragment.A stream of radial artery was identified in 5 patients with Doppler,and no stream was identified in 13 patients.After reduction,the peripheral blood supply of all the affected limbs was good,among which the peripheral blood supply,1 case returned to normal after 5 minutes waiting.Specifically the palpable radial pulse was immediately restored in 14 patients.The palpable radial pulse did not restore but the peripheral blood supply was good in 4 cases.Intraoperative ultrasonography showed that brachial a

关 键 词：彩超 肱骨髁上骨折 血管损伤 

分 类 号：R726.8[医药卫生—儿科]