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[目的]探讨如何安全的手术治疗儿童GartlandⅡ型肱骨髁上型骨折的方法和临床疗效。[方法]38例儿童GartlandⅡ型肱骨髁上骨折,年龄2岁4个月~13岁,平均8.5岁。按Gartland分型:ⅡA型12例;ⅡB型26例。患肘软组织损伤程度按Tscherne分度,Ⅰ度30例,Ⅱ度8例。受伤原因均为意外摔伤,不伴有其他部位的骨折,术前检查患肢均无神经和血管损伤体征。手术在伤后4~48 h内完成。电视透视下手法闭合复位,根据不同的骨折类型采用不同的固定方式,ⅡA型选择肱骨外髁2枚克氏针固定,ⅡB型多用交叉克氏针固定或交叉和外侧三针固定。将骨折端牢靠固定。术后石膏固定6周,骨折愈合后拔针,进行可以忍受的功能锻炼。[结果]本组术后随访10~22个月,平均12.8个月。骨折全部愈合,恢复肱骨远端形态。无角度丢失而需要再次复位的病例。随访发现经过康复锻炼仍有3例肘关节活动范围没有恢复正常,但屈伸功能受限<10°。没有出现针道感染。有1例出现迟发性尺神经麻痹,术后4个月逐渐恢复。无肘内翻畸形。按照F lynn评价标准,优35例,良3例。[结论]闭合手法复位、经皮克氏针固定治疗儿童GartlandⅡ型肱骨髁上骨折的方法,与闭合复位直接石膏固定比较,固定方式可靠,无复位角度丢失需要再次复位的病例,手术创伤小,并发症少,疗效好,是安全可行的治疗GartlandⅡ型骨折的方法。
[Objective] To explore the safe surgical treatment of children with Gartland Ⅱ supracondylar humerus fractures and clinical efficacy. [Method] 38 cases of Gartland Ⅱ supracondylar fracture of the humerus, aged 2 months and 4 months to 13 years old, with an average of 8.5 years old. According to Gartland classification: Ⅱ A type 12 cases; Ⅱ B type 26 cases. Suffering from elbow soft tissue injury by Tscherne degree, Ⅰ degree 30 cases, Ⅱ degree in 8 cases. Injuries were caused by accidental falls, not accompanied by fractures of other parts of the limbs were preoperative examination of nerve and vascular injury signs. Surgery completed within 4 ~ 48 h after injury. TV fluoroscopy approach closed reduction, according to the different fracture types using a different fixation, Ⅱ A type selection of the two lateral humeral Kirschner wire fixation, Ⅱ B multi-purpose cross Kirschner wire fixation or cross and lateral three-pin fixation. The fracture will be firmly fixed. Postoperative gypsum fixed for 6 weeks, the needle after fracture healing, can be tolerated functional exercise. [Results] The patients were followed up for 10 to 22 months with an average of 12.8 months. All fractures healed, restore humeral distal morphology. No angle loss and need to reset the case again. Follow-up found that after exercise rehabilitation there are still 3 cases of elbow range of motion did not return to normal, but limited flexion and extension <10 °. There was no needle infection. One case had delayed ulnar nerve palsy and recovered gradually after 4 months. No cubitus deformity. According to F Lynn evaluation criteria, excellent in 35 cases, good in 3 cases. [Conclusion] The method of closed reduction and percutaneous Kirschner wire fixation for supracondylar fractures of Gartland type Ⅱ in children with closed gypsum fixation is a reliable way to fix gartland type Ⅱ supracondylar fractures in children. There is no need to reset the angle again, Less complications, good efficacy, is safe and feasible method of treatment of Gartland Ⅱ fracture.