尺骨鹰嘴过头位牵引治疗儿童肱骨髁上GartlandⅢ型骨折

Treatment of GartlandⅢ Supracondylar Fracture of Humerus in Children by Overhead of Olecranon Traction

目的探讨尺骨鹰嘴过头位牵引治疗儿童伸直性、闭合型GartlandⅢ型肱骨髁上骨折的适应证、优点及其并发症的处理。方法本组87例,均为伸直性、闭合型GartlandⅢ型肱骨髁上骨折。其中伴尺偏型68例,桡偏型19例,并旋转者18例。均行尺骨鹰嘴过头位牵引治疗,术后第2、5天床旁摄肘关节正侧位X线片,术后7d内根据X线片提示的骨折断端位置进行三维方向调整牵引重量和角度,以达到骨折复位要求。其中5例术后因神经血管受压症状明显,改为切开复位。术后第14天摄片了解骨痂形成情况,拔出牵引钢针,行石膏固定肘关节功能位置,2周左右拆除石膏进行功能锻炼。结果87例中67例均在门诊获得1.5a的随诊,未发现肘内翻畸形。入院时存在神经损伤者,除1例尺神经损伤不恢复,于术后4个月再次行尺神经前置术外,均在出院3个月内恢复。结论尺骨鹰嘴过头位牵引能增加肘关节活动,迅速减轻肘部肿胀和疼痛,改善上肢力线,操作简便,预后良好。但在骨牵引的前5d应特别警惕,若考虑骨折断端间嵌顿有血管、神经或软组织,应立即改为切开复位。

Objective To discuss the indication and complication of overhead traction of olecranon for displaced extension - type Gartland Ⅲ supracondylar fracture of the humerus in children. Methods Total of 87 patients（ Gardand Ⅲ ） proceeded with overhead skeletal traction of ulnar olecranon,including 68 cases of ulnar deviation and 19 cases of radial deviation. Eighteen cases had complicating revolve deviation. According portable X - ray results in the 2nd and 5th, three - dimension adjustment was performed within 1 week. Five patients were treated by open reduction because of symptoms nerves and blood vessel compression. When X - ray examination showed good callus formation and stable reduction ,the patient was discharged after the elbow was stabilized in flexion position with plaster fixation ,which was removed in 2 weeks. Results Sixty - seven of 87 patients were followed - up for 18 months. All of them had excellent results except one who had permanent ulnar nerve injury. No cubitus varus was observed. Conclusions The overhead olecranon skeletal traction is a simple, effective method, because it can increase joint motion,relieve elbow swell and pain rapidly,and improve upper limb line of traction. However,open reduction shall be done promptly if there is evidence of nerve, blood vessel or soft tissue between broken ends of fractured bone within 5 days.