C臂引导下双入路微创治疗儿童肱骨髁上骨折

Minimally Invasive Two-incision Internal Fixation Under C-arm X-ray Monitoring for Humeral Supracondylar Fracture in Children

目的探讨C臂引导下儿童肱骨髁上骨折行双切口入路微创内固定术的可行性及疗效。方法 10例儿童肱骨髁上骨折患者,取肘外侧髁切口为主内侧髁切口为辅的＂一主一辅＂双切口入路,C臂引导下行肱骨髁上骨折复位交叉克氏针内固定。结果本组均获随访,平均3.5（2-5）个月。术后3 d复查X线显示均达解剖复位。本组无术中神经损伤及切断肱三头肌,无感染及术后内固定松动移位发生。骨折均在12周内达骨性愈合,其中6周愈合4例,8周愈合5例,12周愈合1例,无一例骨化性肌炎。肘关节功能按Cassebaum标准评定疗效,优8例,良2例,优良率100%。恢复良好。结论该切口术式对伸肘结构损伤小,肘关节功能恢复良好,并发症少,效果优良。

Objective To explore the feasibility and effect of minimally invasive two-incision internal fixation under C-arm X-ray monitoring for treatment of humeral supracondylar fracture in children.Methods 10 children with humeral supracondylar fracture were treated by reduction and internal fixation with crossing Kirschner wire under C-arm X-ray monitoring.The lateral condyle incision of elbow was applied as a main approach and the medial condyle incision as a secondary approach.Results All the 10 cases were followed up for 2 to 5 months with an average time of 3.5 months.The X-ray exam showed anatomic reduction was achieved in all patients.No complications such as intraoperative nerve injury,triceps brachii muscle cutting,infection,postoperative loosening and translocation of internal fixator were found.All fractures healed in 12 weeks after operation without myositis ossificans,including 4 in 6 weeks,5 in 8 weeks and 1 in 12 weeks.According to Cassebaum standard evaluation,elbow function showed excellence in 8 cases and good in 2 cases,and the fineness rate was 100%.Conclusion The minimally invasive two-incision internal fixation under C-arm X-ray monitoring can achieve a satisfied effect for humeral supracondylar fracture in children with advantages as less damage of elbow extension structures,well elbow functional recovery and few complications.