儿童“不可复性”肱骨髁上骨折的治疗

The Treatment for "Irreducible" Supracondylar Fracture of Humerus in Children

目的：对３５例“不可复性”儿童肱骨髁上骨折采用一种特殊的闭合整复方法。证明非手术方法可以治疗此种骨折。方法：３５例“不可复性”肱骨髁上骨折患儿。平均年龄７．２岁，平均随诊２．７年。整复方法为屈肘３０～５０°位非牵引状态下有限制的轻柔抖动前臂，或控制上臂近端后仍在３０～５０°位沿前臂方向逐渐纵向牵引，使近骨折端脱出“纽孔样”束缚而获得复位。结果：３４例患儿恢复正常的肘关节功能，５例遗留肘内翻（占１４％），１６例合并神经损伤均在短期内恢复。未发生Ｖｏｌｋｍａｎｎ缺血挛缩。结论：应用此种保守治疗方法可获得满意的复位，避免了手术对肘部造成的损伤，并可在较短时间内使肘关节恢复正常功能。

Objective: To demonstrate the results of a special procedure of manipulation used in the treatment for 'irreducible' humeral supracondylar fracture. Materials: 35 cases of 'irreducible' supracondylar fracture of the humerus, 7.2 years old at original injury, were followedup for 2.7 years on average. Methods: The operator gently shakes the forearm without traction or directly pulls the proximal forearm against its anterior aspect with the elbow flexed at 30～50°, so that the distal end of the proximal fragment can be disengaged from the 'buttonhole', and satisfactory reduction can be obtained. Results: Function of the elbow was fully restored in 34 cases. Cubitus varus was found in 5 cases (14%). 16 cases with nerve complications recovered rapidly and completely. No Volkmann's ischemia contracture occurred. Conclusions: Satisfactory reduction can be achieved in the cases of 'irreducible' supracondylar fracture of the humerus by the manipulation, so that surgical intervention, which has been thought to be necessary, can be avoided and the functions of elbow can be restored in a short time.