摘要
目的探讨弹性髓内针固定治疗GartlandⅢ型儿童肱骨髁上骨折临床疗效和治疗体会。方法回顾性分析我院自2013年5月至2015年2月采用弹性髓内针治疗的GartlandⅢ型儿童肱骨髁上骨折共28例，其中男16例，女12例，患儿年龄2岁6个月～11岁，平均年龄5。1岁。所有患儿均为闭合性损伤。在麻醉下和C型臂透视下，先行骨折闭合手法复位，复位满意后取直径合适大小弹性髓内针2枚，折弯后由肱骨近端外侧1．5cm纵行切口穿入肱骨骨髓腔，直至骨折线远端干骺端内固定。上肢绷带悬吊制动。术后定期随访行X线检查，按照Flynn功能评价标准评定疗效。结果本组28例全部获得随访，随访时间6～27个月，平均10．5个月，随访期最短6个月，最长27个月。从临床表现及X线片评估患肢骨折愈合及功能情况，术后1周患肢活动稍受限，术后1个月均去除悬吊绷带并患肢自由屈伸活动，根据骨折愈合情况术后取钉时间最短33d，最长8周。最后一次随访时，所有患儿Baumann角、前倾角均在正常范围内。患儿均未发生伤口感染、髓内针移位，未出现Volkmann挛缩、肘内翻畸形、神经损伤。按照Flyrm功能评分，优25例，良3例。结论弹性髓内针治疗GartlandⅢ型儿童肱骨髁上骨折能避免损伤神经，因切口位置隐蔽，创伤小；内固定稳定无需石膏外固定，能防止前臂Volkmann挛缩的发生，是一种安全、可行的治疗方法。
Objective To explore the application of elastic stable intramedullary nailing （ESNI） technique for Gartland type Ⅲ supracondylar humeral fractures in children. Methods Twenty-eight children of Gartland type Ⅲ supracondylar humeral fractures were analyzed from May 2013 to February 2015. There were 16 boys and 12 girls with an average age of 5.1 （2. 5-11） years. After satisfactory closed reduction, the fractures were fixed with ESIN. Then injured limb suspension was immobilized with bandage. Clinical evaluations were made according to postoperative radiography and the Flynn criteria （functional ＆ cosmetic）. Results During an average follow-up period of 10. 5 （6- 27） months, the outcomes were satisfactory. And there was no instance of Volkmann contracture, elbow varus deformity, cubitus varus or nerve damage. Clinical examinations and radiography were performed for assessments. Suspended bandages were removed and flexion and extension of extremities resumed at 1 month postoperation. The Flynn functional score was satisfactory. Conclusions ESIN technique is both safe and effective for Gartland type Ⅲsupracondylar humeral fracture. And it offers the advantages of avoiding iatrogenic nerve injury, cast-free treatment, miniinvasive incision and prevention of forearm Volkmann contracture.
出处
《中华小儿外科杂志》
CSCD
2016年第10期790-793,共4页
Chinese Journal of Pediatric Surgery
关键词
肱骨髁上骨折
骨折固定术
弹性髓内针
Supracondylar fracture of humerus
Fracture fixation
Elastic stable intramedullary nailing
