儿童肱骨髁上骨折手术治疗方法改良的初步观察

Improvement on skill of surgical operation for the treatment of supracondylar humerus fractures in children

目的探讨改良术式加固儿童肱骨髁上骨折稳定性及纠正肘内翻畸形的效果。方法对30例肱骨髁上骨折患儿采用手术切开复位,近侧端斧形截骨、远侧端V形截骨,然后用2枚克氏针交叉固定,肱三头肌桡侧重叠缝合、浅层向桡侧翻转缝合。术后用石膏托外固定患肢于屈肘90°位3周。随访6～18个月。结果截骨改良治疗组的30例,优22例,良6例,差2例,优良率达93.33%,无1例肘内翻畸形;而传统治疗组优良率只有62.50%。两组比较差异有显著性(χ2=6.03,P<0.05)。结论该技术为一种操作简单、损伤小,手术并发症少、效果好的方法,值得临床推广。

[Objective] To analyze the clinical effects of supracondylar humerus fractures in children treated with improvement on skill of surgical operation for strong stable fixation and the cubitus varusel deformity were corrected. [Methods] 30 cases of supracondylar humerus fractures were treated by open reduction ,then operating ax shape osteotomy in the near fracture segment and V shape osteotomy in the fracture distal segment, and were fixed with two crossed Kirschner＇s wires. The radial side of brachial triceps muscle was adopted by overlapping suture and sewed up the shallow layer and overturn it towards the radial side. It was supported with plaster slab at 90° flexion for 3 weeks. The patients were followed up for 6 -18 months, and evaluated of clinical effect. [Results] The patients with treatment by modified osteotomy, 22 cases obtained excellent, 6 good, 2 poor, the rate of excellent and good was 93.33%, no cubitus varus happened. The rate of excellent and good was 62.50% in conventional treatment groups. The difference between the two groups was significant on the chi-square test（X^2=6.03, P 〈0.05）. [Conclusion] This technique is easy to operate and has of few complications with minimal damage and better effect, and worth to widely application in orthopaedic clinic practice.