摘要
目的总结儿童Gartland Ⅱ、Ⅲ型肱骨髁上骨折治疗经验。方法 2015年1月—2017年1月收治45例肱骨髁上骨折患儿,其中男28例,女17例;年龄1～13岁,平均5.7岁。致伤原因:运动摔伤43例,高处坠落伤2例。骨折按Gartland分型,Ⅱ型12例,Ⅲ型33例。受伤至手术时间2～12 h,平均4.6 h。先行闭合复位,其中12例Gartland Ⅱ型闭合复位均获得成功;GartlandⅢ型患儿中20例闭合复位成功,11例复位失败者及2例合并桡神经损伤者改行前方横切口辅助复位。复位成功后行经皮交叉克氏针固定。结果手术时间16～52 min,平均32 min;C臂X线机透射次数4～17次,平均6.7次;住院时间3～7 d,平均4 d。45例患儿均获随访,随访时间8～20个月,平均12个月。3例GartlandⅢ型闭合复位患儿术后出现尺神经麻痹,1～3个月后恢复。术后骨折均骨性愈合,愈合时间2～3个月。无切口感染、Volkmann肌挛缩等并发症发生。术后6个月肘关节功能评分:闭合复位者获优16例、良12例、一般4例,优良率87.5%。其中Gartland Ⅱ型优9例、良3例,优良率100%;GartlandⅢ型优7例、良9例、一般4例,优良率80%。前方横切口辅助复位者获优7例、良5例、一般1例,优良率92.3%。结论 Gartland Ⅱ、Ⅲ型肱骨髁上骨折可先闭合复位,对复位失败者采取前方横切口辅助复位,成功后行经皮交叉克氏针固定,手术操作简便、创伤小、术中射线暴露较少,术后功能良好。
Objective To analyze the treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus in children. Methods Between January 2015 and January 2017, 45 cases of Gartland type Ⅱ and Ⅲsupracondylar fracture of the humerus were treated. There were 28 boys and 17 girls with an age of 1-13 years（mean,5.7 years）. The causes of injury included sports injury in 43 cases and falling from height in 2 cases. Fractures were classified as type Ⅱ in 12 cases and type Ⅲ in 33 cases according to Gartland classification. The time from injury to operation was 2-12 hours（mean, 4.6 hours）. All fractures were treated with closed reduction first, and 12 cases of Gartland type Ⅱ fracture were successful in closed reduction; 20 cases of Gartland type Ⅲ fracture were successful in closed reduction, 11 cases with reduction failure and 2 cases with radial nerve injury underwent assisted anterior transverse approach reduction. Then percutaneous crossed Kirschner wires fixation was performed. Results The operation time was 16-52 minutes（mean, 32 minutes）. The perspective frequency was 4-17 times（mean, 6.7 times）. The hospitalization time was 3-7 days（mean, 4 days）. All the 45 cases were followed up 8-20 months（mean, 12 months）. The ulnar nerve paralysis occurred in 3 cases of Gartland type Ⅲ fracture that were treated with closed reduction, and recovered after 1-3 months. All fractures healed after operation, and the healing time was 2-3 months. No incision infection, Volkmann muscle contracture, and other complications occurred. The elbow joint function score at 6 months after operation showed that the results of closed reduction was excellent in 16 cases, good in 12 cases, and fair in 4 cases, with the excellent and good rate of 87.5%; in which Gartland type Ⅱ fracture was excellent in 9 cases and good in 3 cases, with an excellent and good rate of 100%, and Gartland Ⅲ was excellent in 7 cases, good in 9 cases, and fair in 4 cases with an excellent and good rate of 80%. The results of assisted anterior transverse approach reduction was excellent in 7 cases, good in 5 cases, and fair in1 case, and the excellent and good rate was 92.3%. Conclusion Gartland type Ⅱ and Ⅲ supracondylar fractures of the humerus can be treated with closed reduction or combined with the assisted anterior transverse approach reduction, then fixed by percutaneous crossed Kirschner wire, which is operational, smaller invasive, and less radiation exposure during operation, while postoperative function is good.
作者
周庆
孔清泉
高博
ZHOU Qing;KONG Qingquan;GAO Bo(Department of Orthopedics, People＇s Hospital of Deyang City, Deyang Sichuan, 618000, P.R.China;Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第6期698-702,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
肱骨髁上骨折
复位
内固定
儿童
Supracondylar fracture of the humerus
reduction
internal fixation
child
