外后侧小切口交叉针联合前臂旋后位石膏托固定治疗儿童GartlandⅢ型肱骨髁上骨折

Kirschner wires and tension-band fixation through posterolateral minimal incision combined with plaster fixation at supinated position for the treatment of Gartland typeⅢsupracondylar humeral fractures in children

目的:评估外后侧小切口交叉克氏针钢丝张力带内固定治疗GartlandⅢ型儿童肱骨髁上骨折的临床疗效。方法:自2005年1月至2010年12月,共62例GartlandⅢ型儿童肱骨髁上骨折患者,男38例,女24例,年龄2～14岁,平均6.8岁。致伤原因均为跌伤,均为新鲜骨折,受伤至手术时间5～20h。采用外后侧小切口、交叉克氏针张力钢丝内固定,术后石膏托外固定于屈肘90°、前臂旋后、掌心向上位。术后10～12周,根据骨折愈合情况摘除克氏针及钢丝。分析相关临床指标和Flynn标准评定疗效。结果:手术时间30～50min,平均45min。切口均甲级愈合,所有病例无针尾部穿出切口造成的钉道感染,无医源性神经、血管损伤、异位骨化,骨折全部愈合。60例患儿获随访,时间6～24个月,平均15个月。术后6个月复查,按Flynn标准:优48例,良9例,差3例。其中差的3例为轻度肘内翻,内翻角均约6°,功能不受影响。结论:外后侧小切口交叉克氏针钢丝张力带内固定治疗GartlandⅢ型儿童肱骨髁上骨折具有显露清楚、固定牢靠的优点,可有效预防肘内翻的发生,是GartlandⅢ型儿童肱骨髁上骨折的一种实用有效的治疗方法。

Objective ：To evaluate the efficacy of Kirschner wires and tension-band fixation through posterolateral minimal incision for the treatment of displaced supracondylar humeral fractures in children. Methods： From January 2005 to December 2010,there were 62 children （38 males and 24 females,ranging in age from 2 to 14 years,averaged 6.8 years） with Gartland typeⅢ supracondylar humeral fractures. All the injuries were caused by falling, and all the fractures were fresh injuries. The duration from injury to surgery ranged from 5 to 20 hours. All the children were treated with open reduction through a postero- lateral minimal approach, Kirschner wires and tension-band fixation, and were fixed with plaster at 90 degree of elbow flexion, forearm supination, and palms facing upwards. The Kirschner pins and wires were removed after fractures healing. The Flynn＇s criterion was used to evaluate therapeutic effects. Results ：The operation time ranged from 30 to 50 rain （averaged 45 rain）. All the patients achieved solid union. Sixty patients were followed up ,and the mean follow-up time was 15 months （ranged from 6 to 24 months） . At the 6th month after operation, 48 patients got an excellent result, 9 good, 3 bad （light cubitus varus with varus angle about 6 degree,without infection on function） according to Flynn＇s criteria. There were no complications such as procedure-related pin tract infection, iatrogenic nerve and vascular injuries and myositis ossificans. Conclusion：The Kirschner wires and tension-band fixation through posterolateral minimal incision approach can abtain clearer surgical field ,simple in operation, and few wound complications. Therefore ,this modified treatment is an effective and reliable method for pediatric displaced Gartland type m supracondylar humeral fractures.