儿童肱骨髁上骨折经皮克氏针治疗的临床疗效

Close reduction and percutaneous Kirschner wire fixation in management of humeral supracondylar fracture in children

目的分析微创手术治疗儿童肱骨髁上骨折的临床疗效。方法回顾分析我科自2000年8月至2007年10月采用微创手术治疗儿童肱骨髁上骨折获得随访46例，其中伸直尺偏型25例，伸直桡偏型21例。按Garland分型：Ⅰ型7例，Ⅱ型11例，Ⅲ型28例。患儿平均年龄为6岁2个月（1．6～8岁）。手术方式为全身静脉麻醉下先在“C”型臂X线机引导下闭合复位，然后经皮穿入2～3枚克氏针固定骨折，并应用上肢石膏固定肘、腕关节于功能位。结果本组46例获得随访，平均随访时间为10个月（3～36个月）。所有患者均获得骨性愈合，患侧肘关节活动度：平均伸直角度为0°，平均屈曲角度为135。，无1例出现Volkmann挛缩及医源性神经损伤，1例患者出现肘内翻畸形。结论微创手术治疗儿童肱骨髁上骨折具有创伤小、骨折固定稳定、防止Volkmann挛缩以及肘关节功能恢复良好等优点；但骨折复位不良，尤其是尺偏未恢复可能导致肘内翻畸形。

Objective To analyze the clinical therapeutic effect of close reduction and percutaneous Kirschner wire fixation in treating humeral supracondylar fracture in children. Methods We retrospectively analyzed 46 children who had humeral supracondylar fracture treated in our department from August 2000 to October 2007. They were 1.6 to 8 years old （ mean age ： 6 years and 2 months）. Twenty-five had extension-ulnar type humeral supracondylar fracture and 21 deviation-ulnar type. According to Garland typing, 7 children had type Ⅰ fracture, 11 type Ⅱ and 28 type Ⅲ. Closed reduction was performed guided by C-arm X-ray machine when the patients were under general anesthesia. Then the fracture was percutaneously fixed with 2 or 3 Kirschner wires of 1.5 mm, and the elbow and wrist joints were fixed in the functional position with upper limb plaster. Results All patients were followed up for average 10 months （3 -36 months）. All patients obtained bone union. The mobility of elbow joint at the injured side： the average extending angle is 0° and the average flexion angle is 135°. No Volkmann contracture or iatrogenic nerve injury occurred, but cubitus varus deformity happened in one case. Conclusion Close reduction and percutaneous Kirschner wires fixation for humeral supracondylar fracture in children possess the advantages, i.e. small injury and stable bone fixation, in addition, can prevent Volkmann contracture and achieve good elbow joint function recovery. However, that the ulnar deviation is not corrected during fracture reduction may lead to cubitus varus deformity.