中国修复重建外科杂志

中国修复重建外科杂志

儿童 Gartland Ⅱ 型 及 Ⅲ 型肱骨髁上骨折的治疗

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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;Gartland Ⅲ 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 Gartland Ⅲ 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%;Gartland Ⅲ 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。

ObjectiveTo analyze the treatment of Gartland type Ⅱ and Ⅲ supracondylar fracture of the humerus in children.MethodsBetween January 2015 and January 2017, 45 cases of Gartland type Ⅱ and Ⅲ supracondylar 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.ResultsThe 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 in 1 case, and the excellent and good rate was 92.3%.ConclusionGartland 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.

关键词: 肱骨髁上骨折; 复位; 内固定; 儿童

Key words: Supracondylar fracture of the humerus; reduction; internal fixation; child

引用本文: 周庆, 孔清泉, 高博. 儿童 Gartland Ⅱ 型 及 Ⅲ 型肱骨髁上骨折的治疗. 中国修复重建外科杂志, 2018, 32(6): 698-702. doi: 10.7507/1002-1892.201710021 复制

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