儿童严重不稳定型肱骨髁上骨折的治疗体会:(附Gartland Ⅳ型8例报告)

Effects of treatment on children with severe unstable supracondylar fractures(Gartland Ⅳ):A report of 8 cases

目的探讨严重移位的,而且在屈曲及伸直位置均不稳定的小儿肱骨髁上骨折Gartland Ⅳ型的外科治疗。方法对2008年3月～2010年8月我院收治的8例儿童严重的GartlandⅣ型肱骨髁上骨折的手术治疗疗效进行评价,并分析此类型小儿肱骨髁上骨折手法复位失败的原因和切开复位克氏针固定的治疗效果。结果 8例Gartland Ⅲ型肱骨髁上骨折患儿均接受切开复位及克氏针内固定术,早期进行肘关节功能锻炼,总体效果良好。随访1～3年,无一例发生骨不连,肘内翻,神经损伤。结论 Gartland Ⅲ型肱骨髁上骨折切开复位仍是主要治疗手段。同时,早期进行肘关节功能锻炼,是提高本种类型骨折治疗疗效、防止肘内翻畸形发生的关键。

Objective To investagate the effect of surgery on less common pediatric Gartland I IV-type supracondylar humerus fractures. Methods 8 cases of children with severe humerus supracondylar fractures （Gartland IV type）, admitted from March 2008 to August 2010 in Department in Pediatric Orthopaedics of the First Hospital of Xiamen, were investigated and evaluate the efficacy of surgical treatment. Results 8 patients with Gartland IV supracondylar humerus fractures underwent both open reduction and Kirschner wire fixation, and received functional exercise of the elbow in the early stages. The effect of surgery was good for all patients, as showed no case of nonunion, cubitus varus and nerve damage in one to three years follow-up time. Conclusion Open reduction is still the main means for children with Gartland IV supraeondylar humerus fractures. In addition, early functional exercise is to improve the efficacy of the types of fractures and prevent cubitus varus deformity.