石膏与夹板配合应用治疗儿童Gartland Ⅲ型肱骨髁上骨折

Plaster combined with splint for the treatment of Gartland type Ⅲ humeral supracondylar fractures in children

目的:探讨石膏与夹板结合外固定治疗儿童难复性肱骨髁上骨折(Gartland Ⅲ型)的方法及疗效。方法:对2002年3月至2006年5月治疗的24例Gartland Ⅲ型肱骨髁上骨折患儿进行回顾性分析,其中男14例,女10例;年龄4～12岁,平均6.6岁;左侧10例,右侧14例。对患儿先施行手法复位,以能维持肱骨长度,不强求解剖复位,石膏外固定5～7d,肿胀消退后根据复位情况进行再次手法复位矫正,改用夹板外固定4～5周直至骨折愈合。结果:24例均获随访,时间5个月～2年,平均1.2年。所有病例无神经血管损伤、骨化性肌炎、前臂骨筋膜室综合征与Volkmann挛缩等并发症。按照朱小庭儿童肱骨髁上骨折疗效评定标准进行评定,优12例,良8例,可3例,差1例。结论:应用石膏与夹板配合治疗儿童Gartland Ⅲ型肱骨髁上骨折,可以避免反复整复而加重骨折断端及周围软组织损伤,动态矫正骨折端,获得满意的复位,减少并发症的发生,并能在较短时间内恢复肘关节功能。

Objective：To study clinical effects of plaster combined with splint for the treatment of Gartland typeⅢhumeral fractures.Methods：From March 2002 to May 2006,24 children with humeral supracondylar fractures of Gartland typeⅢwere reviewed.Among the patients,14 patients were male and 10 patients were female,ranging in age from 4 to 12 years,averaged 6.6 years.Ten patients had injuries in the left and other 14 patients had injuries in the right limb.Firstly,the patients were treated with manipulative reduction to maintain the length of humerus without emphasis on anatomic reduction.Then,the patients were treated with external fixation using plaster for 5 to 7 days,and secondary manipulative reduction after swelling disappeared.Lastly,the patients were treated with external fixation using splint for 4 to 5 weeks until fracture union.Results：All the patients were followed up,and the duration ranged from 5 months to 2 years,with an average of 1.2 years.All the patients had no complications such as neurovascular injury,myositis ossificans,forearm compartment syndrome and Volkmann contracture.According to ZHU Xiao-ting evaluation criteria for humeral supracondylar fractures in children,12 patients got an excellent result,8 good,3 poor and 1 bad.Conclusion：Treatment of child humeral supracondylar fractures with plaster and splint has several advantages such as avoiding serious soft tissue injuries around fractures due to many times reduction,fracture dynamic correction to obtain satisfactory reduction,reducing complications,obtaining good reduction,and restoring elbow function in a relatively short period of time.