闭合复位经皮穿针内固定治疗儿童肱骨髁上骨折  

Treatment of supracondylar fracture of humerus in children by closed reduction and percutaneous pin fixation

作　　者：冯铜铜 贾昊若 杨烨 屈继宁 颉强 Feng Tongtong;Jia Haoruo;Yang Ye(Children's Osteopathy Hospital,Xi'an Medical College.Xi'an 710000.China)

机构地区：[1]西安医学院,710000:2.西安交通大学附属红会医院儿童骨病医院,710054

出　　处：《美中国际创伤杂志》2023年第1期16-18,21,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的:介绍采用手法闭合复位经皮穿针内固定治疗儿童肱骨髁上骨折的方法及治疗体会。方法:2016年6月至2018年12月共收治58例儿童肱骨髁上骨折患者,男32例,女26例;年龄1~14岁,平均6.3岁。左.侧33例,右侧25例。骨折Gartland分型:Ⅱ型16例,Ⅲ型42例,均采用手法闭合复位经皮穿交叉针内固定治疗,术后给予石膏或者支具外固定治疗,每周拍片1次,4w后拍片检查骨愈合后拆除外固定石膏及支具,拔出克氏针内固定,开始循序渐进功能锻练。患儿受伤至就诊时间为1h~3d,平均24h。均采用闭合手法复位经皮交叉克氏针内固定。术后6个月参照Flynn肘关节功能评分标准评定疗效。结果:58例患儿术后获1、3.6、12个月(平均6个月)随访,最短3月,最长12月。术后6个月参照Flynn肘关节功能评分标准评定疗效:优49例,良8例,可1例。所有患者骨折愈合时间平均为4.8w(4~6w)。患者肘关节功能最短2月恢复正常,最长3月恢复正常,无外漏克氏针松动移位发生、无肘内翻发生、无尺神经损伤。结论:闭合复位经皮交叉克氏针内固定方法治疗儿童肱骨髁上骨折,避免了切开复位内固定,减少了手术损伤,术后肘关节功能恢复良好,是治疗儿童肱骨髁上骨折简单、安全、有效的方法,值得临床推广。Objective:To introduce the method and experience of treating supracondylar fracture of humerus in children by closed reduction and percutaneous pin internal fixation.Methods:From June 2016 to December 2018,58 children with supracondylar fracture of the humerus were treated,including 32 male and 26 female,with an average age of 6.3 years(range,1-14 years).There were 33 cases on the left side and 25 cases on the right side.According to Gartland classification,16 cases were typeⅡand 42 cases were TypeⅢ.All cases were treated with manual closed reduction and percutaneous cross-pin fixation,after 4 weeks,X-ray was taken to check the bone healing and remove the external fixation plaster and brace,pull out the Kirschner wire for internal fixation and begin the progressive functional exercise.?The average time from injury to treatment was 24 hours,ranging from 1 hour to 3 days.All cases were treated with closed reduction and percutaneous cross Kirschner wire fixation.?Flynn's elbow function score was used to evaluate the effect 6 months after surgery.Results:58 cases were followed up for 1,3,6,12 months(mean 6 months),the shortest period was 3 months,the longest period was 12 months.Six months after the operation,according to Flynn's elbow function evaluation standard,the results were excellent in 49 cases,good in 8 cases and fair in 1 case.The average time of fracture healing was 4.8 weeks(4-6 weeks).The function of elbow joint returned to normal in the shortest 2 months and the longest 3 months.There was no leakage of Kirschner wire,no cubitus varus and ulnar nerve injury noted.Conclusion:Closed reduction and percutaneous cross pin internal fixation for supracondylar fracture of humerus in children can avoid open reduction and internal fixation,reduce operative injury and recover the function of elbow joint well after operation,it is a simple,safe and effective method to treat supracondylar fracture of humerus in children.

关 键 词：闭合复位 经皮穿克氏针 儿童 肱骨髁上骨折 

分 类 号：R68[医药卫生—骨科学]