钛制弹性髓内钉治疗儿童肱骨高位髁上骨折及交界性骨折

Clinical application of flexible titanium intrameduUary nailing for the treatment of upper supracondylar fractures or the distal humeral metaphyseal-diaphyseal junction fractures in children

目的介绍采用钛制弹性髓内钉固定高位髁上骨折及肱骨远端骨干干骺端交界性骨折的方法及初步治疗体会。方法2009年1月至2011年7月，对10例这两种类型的骨折采用了钛制弹性髓内钉治疗。男7例，女3例；左侧4例，右侧6例；年龄2～12岁。高位髁上骨折5例，交界性骨折5例；其中斜形骨折4例，横形骨折6例。患儿均于受伤后24h内入院麻醉下行闭合复位钛制弹性髓内钉固定。术后上肢功能位石膏固定3周，3至6个月拔除弹性髓内钉。结果所有10例患儿均于术后1个月，3个月，6个月及12个月获随访，随访期最短2个月，最长21个月。从影像学及临床两方面对患儿进行评价，测定所有患儿最后一次随访的Baumann角（sF均71．1。，64。～78。）、肱骨前线（均通过肱骨小头中1／3）且与肱骨小头中轴的夹角（37．5。，35。～40。），均在正常范围。肘关节功能最短在术后1．5个月，最长在术后3个月恢复正常，无一例功能受限。未发生尺神经损伤，无针尾激惹感染，弹性钉固定稳定无移动，无骨折再移位。结论高位髁上骨折及肱骨远端骨干一干骺端交界性骨折应视作髁上骨折中的两种特殊类型，治疗上应与常规髁上骨折区别对待，利用弹性髓内钉治疗这两类骨折可以获得较强的稳定性，且操作简单，安全，创伤小，并发症少，值得在临床推广应用。

Objective To discuss the advantages and disadvantages of using flexible titanium in- trarnedullary nailing for the treatment of upper supracondylar fractures or the distal humeral metaphy- seal-diaphyseal junction fractures in children. Methods Between 2009 and 2011, 5 supracondylar hu- meral fractures and 5 metaphyseal-diaphyseal junction fractures of the distal humerus underwent this procedure at our institution. In 4 patients, the fracture line was oblique, and in 6 patients, the frac- ture line was transverse. Results All these patients were followed up at 1,3,6, 12 months （ ranged from 2 to 21 months）. All of the cases have healed well. Baumann＇ s angle （average 71.1°,64°～78°） , and the lateral humeral- capitellar angle（average 37. 5°, 35°～40°） were all within normal range at the latest follow-up. All patients achieved free range of movement of the affected elbow. No visible malpo- sitions, pseudo- arthrosis or nerve lesions were observed. Conclusions Using flexible titanium intr- amedullary nailing technique may get optimal outcomes for children with upper supracondylar humeral fractures or the distal humeral metaphyseal-diaphyseal junction fractures. These should be differentia- ted from the more common supracondylar humerus fracture.