肘前横切口治疗儿童闭合复位失败的GartlandⅢ型肱骨髁上骨折早期临床疗效  

Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland typeⅢsupracondylar humerus fractures in children

作　　者：邓银栓 白静[1] 刘锐 达朝明 颜维舜 陈真 李硕 屈涛 牛伟民 郭斌斌 杨志云 李国海 南国新[3] DENG Yinshuan;BAI Jing;LIU Rui;DA Zhaoming;YAN Weishun;CHEN Zhen;LI Shuo;QU Tao;NIU Weimin;GUO Binbin;YANG Zhiyun;LI Guohai;NAN Guoxin(Department of Orthopedics,Gansu Maternal and Child Health Hospital(Gansu Provincial Central Hospital),Lanzhou Gansu,730050,P.R.China;Department of Orthopedics,Gansu Linxia Pukang Hospital,Linxia Gansu,731100,P.R.China;Department of Orthopedics,Children’s Hospital of Chongqing Medical University,Chongqing,400014,P.R.China)

机构地区：[1]甘肃省妇幼保健院(甘肃省中心医院)骨科,兰州730050 [2]甘肃临夏普康医院骨科,甘肃临夏731100 [3]重庆医科大学附属儿童医院骨科,重庆400014

出　　处：《中国修复重建外科杂志》2023年第5期566-571,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：兰州市科技计划项目(2022-ZD-64)。

摘　　要：目的探讨肘前横切口治疗儿童闭合复位失败的GartlandⅢ型肱骨髁上骨折(supracondylar humerus fractures,SHFs)的早期临床疗效。方法2020年7月—2022年4月,采用肘前横切口内外髁交叉克氏针固定治疗20例儿童闭合复位失败的GartlandⅢ型SHFs。男9例,女11例;年龄1.1~6.0岁,平均3.1岁。致伤原因:摔伤12例,高处坠落伤8例。入院至手术时间为7~18 h,平均12.4 h。术后观察切口愈合情况及有无神经损伤、肘内翻等并发症发生;记录并比较拆除石膏、拔除克氏针及末次随访时肘关节屈伸活动度,以及末次随访时健患侧肘关节屈伸及前臂旋转活动度;X线片上测量Baumann角并观察骨折愈合情况。末次随访时根据Flynn肘关节功能评定标准评价疗效。结果术后切口均Ⅰ期愈合,无皮缘坏死、瘢痕挛缩、尺神经损伤及肘内翻发生。2例术后出现患侧拇指桡背侧疼痛。术后2~4周(平均2.7周)拆除石膏并开始肘关节屈伸锻炼;4~5周(平均4.3周)拔除克氏针。20例患儿均获随访,随访时间6~16个月,平均12.4个月。骨折愈合时间4~5周,平均4.5周,无延期愈合、骨化性肌炎等并发症发生。术后肘关节屈伸活动度逐渐改善,拆除石膏、拔除克氏针及末次随访间比较差异均有统计学意义(P<0.017);末次随访时健患侧间肘关节屈伸及前臂旋转活动度差异均无统计学意义(P>0.05)。术后即刻、拔除克氏针及末次随访时Baumann角比较差异均无统计学意义(P>0.05)。末次随访时根据Flynn肘关节功能评定标准评价,获优16例、良4例,优良率100%。结论肘前横切口内外髁交叉克氏针固定治疗儿童闭合复位失败的GartlandⅢ型SHFs,骨折后方软组织铰链完整,易于复位穿针固定,切口小、并发症少、骨折愈合快、功能恢复早、复位质量与固定可靠,可获得满意疗效。Objective To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland typeⅢsupracondylar humeral fractures(SHFs)in children.Methods Between July 2020 and April 2022,20 children with Gartland typeⅢSHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision.There were 9 boys and 11 girls with an average age of 3.1 years(range,1.1-6.0 years).The causes of injuries were fall in 12 cases and fall from height in 8 cases.The time from admission to operation ranged from 7 to 18 hours,with an average of 12.4 hours.The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation;the elbow flexion and extension range of motion after removing the gypsum,after removing the Kirschner wire,and at last follow-up were recorded and compared,as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides;the Baumann angle was measured on the Xray film,and the fracture healing was observed.At last follow-up,the effectiveness was evaluated according to the Flynn elbow function evaluation criteria.Results All incisions healed by first intention,and there was no skin necrosis,scar contracture,ulnar nerve injury,and cubitus varus.Postoperative pain occurred in the radial-dorsal thumb in 2 cases.The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks(mean,2.7 weeks)after operation,and the Kirschner wire was removed at 4-5 weeks(mean,4.3 weeks).All the 20 patients were followed up 6-16 months,with an average of 12.4 months.The fracture healing time was 4-5 weeks,with an average of 4.5 weeks,and there was no complication such as delayed healing and myositis ossificans.The flexion and extension range of motion of the elbow joint gradually improved after operation,and there were significant differen

关 键 词：肱骨髁上骨折 肘前横切口 内固定 闭合复位失败 儿童 

分 类 号：R726.8[医药卫生—儿科]