小切口穿针术在儿童Gartland Ⅲ型肱骨髁上骨折的应用

OPERATIVE TREATMENT OF GARTLAND TYPE Ⅲ HUMERAL SUPRACONDYLAR FRACTURES IN CHILDREN WITH MINIMALLY INVASIVE INCISION AND PERCUTANEOUS PINNING

目的探讨小切口穿针术治疗儿童Gartland Ⅲ型肱骨髁上骨折的手术方式和治疗效果。方法 2002年9月-2009年7月,收治189例儿童Gartland Ⅲ型肱骨髁上骨折。男137例,女52例;年龄1～13岁,平均6.2岁。运动伤173例,车祸伤9例,高处坠落伤5例,地震伤2例。伴其他部位骨折11例;桡神经损伤36例,正中神经损伤5例,尺神经损伤2例;肱动脉断裂2例。受伤至入院时间1h～10d。采用小切口穿针术治疗骨折,同期行神经、血管探查修复。结果术后切口均Ⅰ期愈合,无相关并发症发生。143例获随访,随访时间5个月～5年,平均12个月。X线片示骨折均愈合,愈合时间2～4个月,平均2.5个月。6例发生肘内翻,但肘关节屈伸功能基本正常;其中2例行肱骨远端楔形截骨矫形术,余继续功能锻炼。肘关节功能评价参照Flynn等临床功能评定标准:优121例,良15例,可7例,优良率95.1%。术后切口未遗留明显瘢痕,神经、血管损伤者术后功能均基本恢复正常。结论小切口穿针术治疗儿童Gartland Ⅲ型肱骨髁上骨折具有创伤小、手术时间短、操作简便、手术并发症少的优点。

Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type Ⅲ humeral supracondylar fracture in children.Methods From September 2002 to July 2009,189 patients with Gartland type Ⅲ humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning.There were 137 males and 52 females,aged from 1 to 13 years（6.2 years on average）.Injury was caused by sports in 173 cases,by traffic accident in 9 cases,by falling from height in 5 cases,and by earthquake in 2 cases.All fractures were closed fractures,complicating others fracture in 11 cases,radial nerve injury in 36 cases,median nerve injury in 5 cases,ulnar nerve injury in 2 cases,and brachial artery injury in 2 cases.The time from injury to hospitalization was 1 hour to 10 days.Neurovascular repair was performed at the same period.Results All incisions healed by first intention,no related complications occurred.A total of 143 patients were followed up 5 months to 5 years（12 months on average）.X-ray films showed fracture healed within 2-4 months（2.5 months on average）.Cubitus varus occurred in 6 cases,but the functions of elbow flexion and extension were good;2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training.According to the Flynn et al criteria,the results were excellent in 121 cases,good in 15 cases,and fair in 7 cases;the excellent and good rate was 95.1%.Only a small incision scar was found,the function returned to normal in the cases complicated by nerve and blood vessel injury.Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type Ⅲ humeral supracondylar fracture in children is a safe and effective surgical procedure,which has minimal trauma,short surgery time,quick recovery,simple operation,and can be effective in reducing the complications.