双张力带内固定治疗儿童肱骨远端A型骨折的临床研究

Clinical study of double tension bands for treatment of type A fractures of distal humerus in children

[目的]探讨双张力带（DTB）内固定治疗儿童肱骨远端A型骨折的手术治疗方法及临床疗效。[方法]自1999年1月～2005年5月间采用DTB内固定术治疗儿童肱骨远端A型骨折52例。开放骨折7例（GustiloⅠ型5例，Ⅱ型2例）；闭合骨折45例。按照AO／ASIF分型标准：A2型41例，A3型11例。屈肘功能位石膏固定2周，术后2—3周开始功能锻炼。[结果]所有病例均获得随访，时间6—18个月，平均12．5个月，骨折均愈合，无肘内翻畸形。肘关节功能按Flynnet评定标准进行评定，优41例，良10例，差1例。[结论]DTB内固定术具有操作简便、直视下解剖复位、固定可靠、有利于术后功能锻炼及并发症少等优点，是治疗儿童肱骨远端A型骨折的较好选择。

[ Objective] To evaluate the surgical management and its results of type A fractures of distal humerus in children utilized with double tension hands （DTB）. [ Method] From January 1999 to May 2005,52 patients of type A fractures of distal humerus in children were treated surgically through approach of DTB. Seven patients suffered open fractures （ Gustilo scale Ⅰ in 5, and Ⅱ in 2）. Fourty-five patients suffered closed fractures. According to AO/ASIF classification, type A2 fracture was found in 41 cases and type A3 in 11 cases. The elbows were flexed to 90°and immobilized with long-ann casts for 2 weeks. The rehabilitation exercises began at 2 - 3 weeks post-operatively. [ Result] All the patients were followed up, with the duration from 6 to 18 months （ averaged, 12.5 months）. All the fractures were healed,no cubitus varus deformity. The function of the elbow was evaluated according to Flynnet＇s scale, the results showed excellent in 41 cases,good in lOcases, and poor in 1 case. [ Conclusion] The use of DTB for the surgical management of type A fractures of distal humerus in children has many advantages, it provides a new sufficient internal fixation with simple technical procedure, anatomical reduction under direct vision, reliablestability, facilitates rehabilitation exercises and low complication rate. DTB is a better choice in treatment of type A fractures of distal humerus in children.