经肘后不同入路三针交叉固定治疗儿童肱骨髁上骨折

The treatment on supracondylar fractures of humerus by different approach tri-kirschner fixation

目的:评价经肘后切口不同入路内外髁三针交叉固定治疗儿童肱骨髁上骨折的疗效,探讨优化入路。方法:选择2005年1月～2009年6月,应用内外髁三针交叉固定手术治疗的儿童肱骨髁上骨折81例,均为GarlandⅢ型骨折。按不同入路分组:肱三头肌舌形瓣入路组39例,男25例,女14例;年龄3～11岁,平均5.6岁。肱三头肌正中纵形入路组42例,男27例,女15例;年龄2～12岁,平均6.8岁。术后9周测量肘关节屈伸范围及提携角,参照肱骨髁上骨折疗效评定标准及术后并发症情况,分析2种经肘后切口不同入路的疗效。结果:81例均获得随访,随访时间3～6个月,平均4个月。平均手术时间为肱三头肌舌形瓣入路61min,肱三头肌正中纵形入路52min;肘关节功能恢复正常平均时间为肱三头肌舌形瓣入路8.3周,肱三头肌正中纵形入路6.1周。肱三头肌舌形瓣入路组39例中优21例,良12例,可4例,差2例,39例术后6周均获得骨性愈合,肘内翻畸形1例,尺神经损伤2例。肱三头肌正中纵形入路组42例中优30例,良11例,差1例,肘内翻畸形1例,所有患儿术后6周均获得骨性愈合。结论:儿童肱骨髁上骨折内外髁三针交叉固定,肱三头肌正中纵形入路优于肱三头肌舌形瓣入路。

Objective：To evaluate the clinical outcome of Tri-Kirschner fixation for the treatment of children on supracondylar fractures of humerus by different approach.Methods：From January 2005 to June 2009,82 patients with Garland type Ⅲ supracondylar fracture of the humerus were treated by open reduction,Tri-Kirschner fixation.All cases were devided into two groups for different approach：linguiform valve group tricep dissected in a tongue-shaped flap had 39 cases,the mean age was 5.6 years old （3-11）.Median and longitudinal group tricep dissected in posteries midline had 42 cases,The mean age was 6.8 years old （2-12）.Complications,operation time and rehibilitation time were observed,the elbow function score were recorded.Results：All patiens were follow-up for 3-6 months,an average of 4 months.The mean operation time：lioguiform valve group 61 min,median and longitudinal group 52 min.The mean rehibilitation time：linguiform valve group 8.3 weeks,median and longitudinal group 6.1 weeks.The elbow function score：linguiform valve group,39 cases,21 cases of excellent,good in 12 case,fair 4,poor 2,ulnar nerve injury in 2 cases,cubitus varus deformity in 1 case.Median and longitudinal group,42 cases,30 cases of excellent,good in 11 case,poor in 1 case,cubitus varus deformity in 1 case.No serious postoperative complications.Conclusion：It shows that has better outcome which use of Tri-Kirschner fixation on children＇s supracondylar fracture of humerus by tricep dissected in a tongue-shaped flap than tricep dissected in posteries midline.