儿童Ⅲ型肱骨髁上骨折的早期闭合治疗及前臂缺血性肌挛缩的预防

Closed treatment for typeⅢ humeral supracondylar fractures and prevention of ischemic contracture of forearm in children

目的:评价闭合手法复位治疗儿童肱骨髁上骨折的疗效及早期对前臂缺血性肌挛缩的预防。方法:自2008年9月至2011年9月采用手法复位石膏外固定治儿童Ⅲ型肱骨髁上骨折38例,其中男20例,女18例;年龄2～13岁,平均7.5岁;伤后至就诊时间0.5h～6d,平均1.8d。伸直尺偏型20例,伸直桡偏型17例,屈曲型1例,均不伴神经动脉损伤。骨折早期,正确处理肿胀,采用手法复位、医用护肩配合上肢宽石膏托外固定,根据原始移位方向决定固定体位,定期拍X线片复查,发现再移位者,于术后1～2周内及时调整复位。平均4～6周后根据骨折愈合情况拆除石膏,指导肘关节功能锻炼。根据Dodgt疗效评价标准对肘关节功能进行评定。结果:38例均获随访,时间3个月～1年,平均7个月,骨折全部愈合。采用Dodgt疗效评价标准对患肘关节功能进行评估,优14例,良19例,可4例,差1例。结论:对未合并血管神经损伤的儿童肱骨髁上骨折采用闭合手法复位、医用护肩配合上肢宽石膏托外固定治疗可获得比较满意的临床疗效,早期重视并正确处理肿胀,注意石膏固定角度,可有效预防前臂缺血性肌挛缩的发生。

Objective：To evaluate the curative effects of manipulative reduction for children＇s type Ⅲ humeral supracondylar fracture and the preventions of ischemic contracture of forearm in the early period. Methods：From September 2008 to September 2011,38 patients with humeral supracondylar fractures were treated with manipulative reduction and piaster stabilization, including 20 males and 18 females with an average age of 7.5 years （ranged, 2 to 13 years） ;the average time from injury to visit was 1.8 days（ranged ,0.5 h to 6 d）. There were 21 cases in straighten-ulnar deviation type and 17 cases in straighten-radial deviation type, 1 case in flexion type, all of them without vascular nerve injury. It was important to process swelling correctly in early stage of fracture. To decide fixed position according to the original displacement, and make a regular X-ray review, if found another displacement to correct it in 1-2 weeks after injury in time. Dismantle the plaster on the basis of bone healing and guide the functional exercise of elbow joint. According to Dodgt standard to evaluate clinical effects. Results： All patients were followed up from 3 months to 1 year with an average of 7 months. All fractures healed. According to Dodgt standard, 14 patients got an excellent results, 19 good , 4 fair and 1 poor. The excellent and good rate was 86.84%. Conclusion：It can obtain satisfactory clinical effects to treat humeral supracondylar fracture in children with closed manipulative reduction and plaster stabilization,while without vascular nerve injury. Early correct processing swelling and paying attention to gypsous angle can effectively prevent the ischemic contracture of forearm