肱骨髁上骨折治疗方法改进及并发症防治的探讨

An investigation of the improvement of the management for supracondylar fractures of humerus and prevention of complications

目的:通过改进后的方法治疗肱骨髁上骨折以预防和降低肘内翻的发生。方法:肱骨髁上骨折197例,男167例,女30例;年龄3～12岁,平均8.7岁;伸直型179例,屈曲型18例;其中开放性骨折6例。单纯石膏托外固定34例,手法复位、石膏外固定53例,牵引复位、石膏外固定23例,手术治疗87例。手术者中29例采用肘前外侧切口,58例采用后内侧切口。结果:197例中191例得到随访,时间1～5年,平均3.7年,参考小儿肱骨髁上骨折相关疗效评定,优142例,良27例,可13例,差9例,肘内翻发生8例。结论:肘内翻发生虽有其客观因素,但治疗时只要彻底纠正尺偏倾斜并维持复位后的稳定,可使肘内翻发生率降到最低限度。

Objective：To explore the improvement of the method for the treatment of supracondylar fractures of humerus in order to prevent and decrease the occurrence of cubitus varus. Methods： One hundred and ninety-seven patients with supracondylar fractures of humerus included 167 males and 30 females with an average age of 8.7 years old ranging from 3 to 12 years. There were 179 cases of extention and 18 cases of flexion. Six cases were open fractures. Thirty-four patients of fractures underwent fixation by only piaster slab, 53 underwent manipulative reduction and fixation by plaster slab, 23 underwent traction reduction and fixation by plaster slab, 87 underwent surgical operation. Among the cases of operation, 29 cases adopted anterior-lateral incision of elbow and 85 adopted posterior-interior incision of elbow. Results ： Among the 197 cases, 191 cases were followed up for 1 to 5 years with an average of 3.7 years. According to the correlated curative effect evaluation of supracondylar fractures of humerus ,the results were excellent in 142 cases,good in 27 ,fair in 13 ,poor in 9. Cubitus varus occurred in 8 cases. Conclusion：The objective factors for the occurrence of elbow varus do exist. However, during the treatment of these fracture, if strict correction of the ulnar deviation and stability are maintained during the reduction ,the rate of occurrence of elbow varus could made to decreased a minimum.