手法复位外侧经皮穿针内固定治疗儿童移位肱骨髁上骨折

Manipulative reduction and lateral percutaneous K-wire fixation for treatment of supracondylar humerus fractures in 128 children

目的:探讨采用手法复位外侧经皮穿针内固定治疗移位肱骨髁上骨折的临床疗效。方法:2004年2月至2010年6月对128例移位肱骨髁上骨折采用手法复位外侧经皮穿针内固定治疗,男96例,女32例;年龄2～15岁,平均8岁;均为移位骨折,伸直型112例,屈曲型16例;尺偏型102例,桡偏型26例;全部为闭合性骨折。通过治疗后测量肘关节屈伸范围及提携角,参照Flynn肱骨髁上骨折疗效评定标准及术后并发症情况,分析治疗效果。结果:128例患者均获随访,时间2～36个月,平均16个月。参照Flynn肱骨髁上骨折疗效评定:优116例(90.6%),良11例(8.6%),可1例(0.8%)。无针孔感染、肌缺血性挛缩及尺神经损伤发生。结论:手法复位外侧经皮穿针内固定治疗移位肱骨髁上骨折不但具有操作简单,损伤小,固定牢靠,安全有效且治疗费用低的优点,而且又避免了保守治疗和手术治疗的缺点,是治疗儿童移位性肱骨髁上骨折较好的治疗方法。

Objective：To explore the clinical effect of manipulative reduction and lateral percutaneous K-wire fixation on supracondylar humerus fractures. Methods：From Feb. 2004 to Jun. 2010,128 cases of supracondylar humeros fractures in children （96 boys and 32 girls） were treated by manipulative reduction and lateral percutaneous K-wire fixation. The average age of the children was 8 years old ranging from 2 to 15 years. Among them,112 cases were extension fractures,16 were flexion type;102 cases belonged to ulnar deviation,and 26 cases belonged to radial deviation. After treatment,the elbow flexion range and carrying angle of the children were measured under the Flynn evaluation standard while considering the postoperative complications status to analyze the clinical effect on manipulative reduction and lateral percutaneous K-wire fixation. Results：All these children were followed up from 2 to 36 months （16 months on average）. According to Flynn evaluation standard,the result were excellent in 116 children （90.6% of the total patients）,good in 11 （8.6%）,fair in 1 （0.8%）. No infection,no ischemic muscular atrophy and no nerve damage had been found during the treatment. Conclusion： The manipulative reduction and lateral percutaneous K-wire fixation of supracondylar humerus fractures in children has small wound,is stable and reliable,easy to be operated,safe and effective and low cost. What＇s more,it can also avoid the complication caused by conservative treatment and operation. It is a good treatment of supracondylar humerus fractures in children.