摘要
目的探讨急诊室手法复位石膏外固定后延期行经皮克氏针内固定治疗儿童Ⅲ型肱骨髁上骨折的方法及必要性。方法回顾性分析2008年2月至2013年2月急诊室手法复位石膏固定后延期经皮克氏针内固定手术治疗189例GartlandⅢ肱骨髁上骨折患儿的临床资料。其中，男118例，女71例；年龄2～13岁，平均6．8岁。受伤至急诊室接受手法复位石膏固定时间0．5～8h，平均4．8ho手法复位后所有病例骨折前后及侧方移位均有明显改善，其中115例复位较为满意。复位后收住人院，住院后准备2～7d，平均3．8d，延期行经皮克氏针内固定术。术后屈肘90。石膏固定，3～4周拆石膏、拔除克氏针。术后随访3～48个月，平均12个月。结果本组患儿经急诊室手法复位住院后疼痛VAS评分从平均（6．8±2．3）分下降至（3．2±1．2）分；闭合复位经皮克氏针内固定手术时间10-45min，平均21．4min。术后随访所有患儿骨折均愈合，未发生骨筋膜室综合征及缺血性肌挛缩；出现轻度肘内翻4例，1例2年后出现严重肘内翻需手术。术前合并神经损伤25例，有24例完全恢复，1例尺神经损伤未完全恢复。术后有尺神经损伤2例，3个月内均恢复。结论急诊室超早期手法复位石膏固定后再进行延期经皮克氏针内固定手术治疗方法可以减轻儿童骨折后的痛苦，提高延期手术的成功率，减少肢体肿胀及骨筋膜室综合征等并发症的发生，有效解决了急诊与非急诊手术的争论，是儿童肱骨髁上骨折治疗一种必要和有效的方法。
Objective To investigate the method and necessity of delayed percutaneous pins fixation for type Ⅲ supracondylar fractures of humerus in children after emergency manipulative reduction and plaster fixation. Methods From February 2008 to February 2013, the clinical data of 189 patients with Gartland type Ⅲ supracondylar fractures were reviewed. They underwent delayed percutaneous pinning after emergency manipulative reduction and plaster fixation. There were 118 males and 71 females with a mean age of 6. 8 （2-13） years. The average delay between injury and emergency reduction and plaster fixation was 4. 8 （0. 5-8） hours. Fracture displacement significantly improved after manipulative reduction,including satisfactory reduction （n = 115）. Then all cases were hospitalized. After preparation for a mean length of 3.8 （0. 5-8） days, delayed percutaneous Kirschner wire fixation was performed. Postoperative elbow 90 plaster fixation was applied. Plaster, pins and Kirschner wire were removed after 3-4 weeks. The mean postoperative follow-up period was 12 （3-48） months. Results The mean pain VAS scores decreased from （6. 8 ± 2. 3） to （3.2 ± 1.2） points. And the mean operative duration of closed reduction and percutaneous pinning fixation was 21.4 （10-45） min. All fractures healed without compartment syndrome or ischemic contracture. Among 4 cases of mild cubitus varus, one case of serious elbow varus required surgery after 2 years. And 24/25 cases of preoperative nerve injury fully recovered while one case of ulnar nerve injury had incomplete recovery. Postoperative ulnar nerve injury was restored in 2 cases after 3 months. Conclusions The treatment of delayed percutaneous pin fixation for children type HI supracondylar fractures after manipulative emergency reduction and ultra-early plaster fixation can relieve pain, improve the success rate ofdelayed surgery and reduce extremity swelling and complications. It is an effective solution to the controversy of emergency versus non-emergency surgery for supracondylar fractures in children.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第3期208-211,共4页
Chinese Journal of Pediatric Surgery
关键词
肱骨骨折
手法
骨科
骨折固定术
Humeral fractures Manipulation, orthopedic Fracture fixation
