后正中入路小切口复位经皮克氏针固定治疗严重移位肱骨髁上骨折

Percutaneous Pin Fixation of Completely Displaced Supracondlar Fractures in Children Through Posterior Middle Approach Small-incision

目的：介绍一种后正中入路小切口复位经皮克氏针固定治疗Ⅲ型肱骨髁上骨折的术式。方法：28例GartlandⅢ型肱骨髁上骨折,年龄2~12岁,平均8岁。受伤至接受手术时间4~48小时,平均为16小时。在全麻或臂丛麻醉下,后正中入路显露骨折,解剖复位,屈肘位用1.6mm克氏针从内、外髁交叉打入,交叉点位于鹰嘴窝顶以上。术后屈肘90。功能位石膏固定,2~3周拆石膏,3周拔除克氏针。结果：28例手术克氏针固定后复位满意。针道感染1例,取出后愈合,未影响骨折位置。随访2年,无肘内翻畸形。结论：后正中入路结合经皮克氏针固定,骨折复位精确,并发症少,临床疗效满意。

Objective：To introduce a treatment of completely displaced supracondlar elbow fractures in children with percutaneous cross pin fixation through posterior middle approach small-incision. Methods：28 patients with a mean age of 7-8 years （ rang e 2~ 12 years） were reviewed. The average delay between injury and surgery were 16 hours（ range4~ 48 hours） . Through posterior middle approach small-incision, expose fractures,anatomic reduction,percutaneous lateral and medial pins fixation was applied . Application cast in elbow flexion 90 degree, the cast and pins were removed 3 weeks postoperatively. Results： 27 patients were followed up with clinically satisfactory results after successful percutaneous pin fixation.Three patients developed pin infect ion which did not affect the final reduction position. No cubitus varus during three years follow up.Conclusion： Percutaneo us pin fixation of supracondilar fracture in children throughposterior middle approach small-incision generally satisfactory results with low incidence of complications.