儿童GartlandⅢ型肱骨髁上骨折的手术治疗(附56例报告)

Treatment of gartland's type Ⅲ supracondylar humerus fractures with modified surgical technique without damaging muscles of elbow extension in children

目的探讨采用保留伸肘装置的手术方式治疗儿童GartlandⅢ型肱骨髁上骨折的疗效。方法选择2000年10月～2009年4月我院收治的GartlandⅢ型肱骨髁上骨折患儿56例。患儿平均年龄7.5岁。采用保留伸肘装置的手术方式进行治疗。无伴发血管、神经损伤和筋膜室间隔综合征。结果术后56例获得随访,随访时间为6～15月,平均11.5月。所有骨折均获得愈合。根据Flynn标准进行疗效评价,其中优22例(39.3%),良21例(37.5%),可9例(16.1%),差4例(7.1%)。伤后8 h内手术的优良率为89.7%,伤后8 h后手术的优良率为63.0%。直接手术治疗的优良率为90.1%,曾接受手法复位的优良率为67.7%。结论采用保留伸肘装置的手术方式治疗儿童GartlandⅢ型肱骨髁上骨折可取得满意疗效,是安全、有效的治疗方法。

Objective To explore the surgical outcomes of treatment of Gartland＇ s type Ⅲ supracondylar humerus fractures with modified surgical technique without damaging muscles of elbow extension in children. Methods Fifty - six children with wildly displaced supracondylar fracture of the humerus （ Gartland grade Ⅲ ） had treated by using modified surgical technique without damaging muscles of elbow extension between October 2000 and April 2009. The patients were from 4 to 15 years old, with an average age of 7.5 years. No patient had accompanying neurovascular injuries or compartment syndrome. Results Fifty - six patients were followed - up from 6 months to 15 months, with an average of 11.5 months. All fractures were healed. According to the criteria of Flynn, 22 elbows （39.3 % ） were rated as excellent, 21 （37.5 % ） as good, 9 （ 16.1% ） as fair, and 4 （7.1% ） as poor. The surgical outcomes was good in 89.7% of the eases operated within 8 hours after the injury and 63.0% of the cases operated beyond 8 hours after the injury. The excellent and good rate of the resuhs was higher in pateints treated with primary surgical reduction and fixation （90.1% ） than in patients treated with secondary surgical reduction and fixation after failed attempt of manual reduction. Conclusion It is an effective and safe method and is associated with good outcomes the treatment of Gartland＇ s type Ⅲsupraeondylar humerus fractures with modified surgical technique without damaging muscles of elbow extension in children.