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目的 评价切开复位和闭合穿针治疗小儿严重移位的肱骨髁上骨折的临床效果。方法从1996年至今共收治严重移位的小儿肱骨髁上骨折18例,全部为GartlandⅢ型骨折。采用切开复住交叉克氏针内固定9例,采用闭合复位、经皮克氏针固定治疗9例。复位时注意桡侧嵌紧,伸直尺偏型矫枉过正,桡偏型不强求完全复位。结果 18例病人中有16例获得13个月到4年6个月的随访,无1例出现肘内翻及Volkmann缺血性肌挛缩和并发医源性的迟神经损伤。患侧肘关节伸屈功能丧失10°～15°共2例,为手术病人。闭合穿针组只有1例患儿肘关节伸直较健侧差7°。结论 严重移位的小儿肱骨髁上骨折,采用切开复位交叉克氏针内固定或闭合复位、经皮克氏针固定治疗,固定确切,能避免骨折远端向尺侧的二次移位,无需极度屈肘外固定,因而能防止肘内翻及Volkmann缺血性肌挛缩,效果满意。
Objective To evaluate the clinical effect of open reduction and closed needling in the treatment of supracondylar humerus fractures in children. Methods From 1996 to now, a total of 18 cases of supracondylar humerus fractures were treated in our hospital, all of them were Gartland type Ⅲ fractures. Nine patients with Kirschner wire internal fixation were treated with closed reduction and percutaneous Kirschner wire fixation. Attention to the radial reduction when the tight-fitting tightness, overhang partial deviation overrun, radial partial does not force a full reset. Results 16 of 18 patients were followed up from 13 months to 4 years and 6 months. None of the 18 patients had cubitus varus and Volkmann’s ischemic contracture and iatrogenic delayed nerve injury. Ipsilateral elbow flexion and extension loss of 10 ° ~ 15 ° in 2 cases, for surgery patients. Only 1 patient in the closed needle group had an elbow extension of 7 ° worse than that of the healthy elbow. Conclusions Seriously displaced pediatric supracondylar fracture of humerus is treated with open reduction and cross Kirschner wire internal fixation or closed reduction and percutaneous Kirschner wire fixation. The fixation is accurate and the secondary displacement from the distal to the ulnar fracture can be avoided. Without extreme elbow external fixation, thus preventing elbow varus and Volkmann ischemic contracture, with satisfactory results.