摘要
目的介绍用Swenson方法结合运用绷带手法复位并经皮克氏针固定治疗Ⅲ型肱骨髁上骨折.方法 80例Gartland Ⅲ型肱骨髁上骨折,年龄2～12岁,平均9岁.受伤至接受复位时间2～48 h,平均为8 h.在全麻或臂丛麻醉下,以Swenson 方法牵拉,同时用绷带绕过肘前,产生从前向后的垂直力,屈肘120°旋前或旋后位固定,用1.6 mm克氏针从内、外髁交叉打入,交叉点位于鹰嘴窝顶上.术后屈肘30°～40°石膏固定,3～4周拆石膏.结果 74例经手法复位和克氏针固定后复位满意.6例经3次以上手法复位失败转为开放手术.2例术后有尺神经症状,3个月内恢复.针道感染3例,但不影响复位.轻型肘内翻5例,明显肘内翻需手术1例.3年内同一肢体再发肱骨髁上骨折1例.结论手法复位结合经皮克氏针固定,创伤小,并发症少,临床疗效满意.
Objective To introduce a treatment of completely displaced supracondlar elbow fractures in children with Swenson method combining reduction and percutaneous cross pin fixation. Methods 80 patients with a mean age of 9 years （range 2-12 years） were reviewed. The average delay between injury and surgery was 8 hours（range 2-48 hours）. Closed reduction was performed in theater room under general or local anesthesia depending on the ages with minor modification of Swenson＇s technique. Longitudinal traction was applied to the forearm while counter traction was applied to the proximal humerus. Reduction of the extension deformity was performed with flexion of the elbow to 120 degrees while the surgeon applied a long. The forearm was held in pronation for posteromedial fractures and supination for posterolateral fractures. Percutaneous lateral and medial pins fixation was applied under radiographic control. Application cast in elbow flexion 30 or 40 degree, the cast and pins were removed 3 or 4 weeks postoperatively. Results 74 patients were followed up with clinically satisfactory results after successful closed reduction and percutaneous pin fixation. Eight patients underwent open reduction after three failed attempts of closed reduction. Two patients developed symptoms of ulnar nerve injury which recovery by 3 months postoperatively. Three patients developed pin infection which did not affect the final reduction position. Five patients developed minor cubitus varus and only one case had prominent cubitus varus requiring surgery intervention. One patient had refracture in the same extremity during three years follow up. Conclusions Close reduction and percutaneous pin fixation of supracondilar fracture produces generally satisfactory results with low incidence of complications.
出处
《中华小儿外科杂志》
CSCD
北大核心
2005年第12期646-648,共3页
Chinese Journal of Pediatric Surgery
关键词
肱骨骨折
骨折固定术
Humeral fractures
Fracture fixation
