闭合复位、经皮桡侧交叉克氏针固定治疗儿童Ⅲ型肱骨髁上骨折

Closed reduction and percutaneous radials crossed pinning of gartland type Ⅲ supracondylar fractures of the humerus in children

目的评价闭合复位、经皮桡侧交叉克氏针固定治疗儿童Ⅲ型肱骨髁上骨折的临床效果。方法2002年2月至2007年2月在“C”型臂透视下，采用闭合复位、经皮桡侧交叉克氏针固定治疗儿童Ⅲ型肱骨髁上骨折共53例。患儿年龄2～12．6岁（平均为6岁2个月）。伸直型51例，屈曲型2例。在臂丛或静脉麻醉下和“C”型臂透视下，先行闭合整复骨折，然后经皮桡侧交叉穿入2枚克氏针固定。结果本组49例获得随访，随访时间11～56个月（平均为21个月）。患侧肘关节伸直平均为-8°；屈曲平均为135°。随访时无一例发生Volkmann挛缩、肘内外翻畸形、神经损伤。结论在骨折复位满意后，采用经皮桡侧交叉克氏针固定，能避免损伤尺神经，避免骨折远端向尺侧的再移位，消除了肘内翻形成的因素；无切口，美观，创伤小；不需极度屈肘外固定，能防止前臂Volkmann挛缩的发生；住院时间短，肘关节功能恢复满意。

Objective To review the results of fifty-three children treated for displaced supracondylar fractures of the humerus. Methods All of the fractures were Gartland type Ⅲ and were treated with close reduction and percutaneous radial crossed-pin fixation under C arm guidance. The mean age of patients was 6. 2 years old （range, 2412. 6 years） at the time of the initial injury. The average follow-up was 21 months （range 11 -56 months）. Results Forty-nine patients were examined for function and deformity. There was no cubitus varus, nerve injury or Volkmann＇s contracture at follow- up. Conclusions Closed reduction with percutaneous radial crossed pin fixation is preferred treatment for the Gartland type Ⅲ supracondylar fractures of the humerus in children.