儿童漂浮肘的临床治疗效果

Therapeutic efficacy of ＂floating elbow＂ in children

目的分析漂浮肘受伤的机制，依据病理解剖的类型采取相应的治疗方案，评价儿童漂浮肘治疗的疗效，探讨儿童漂浮肘的治疗体会。方法对2005年6月至2012年10月在我院治疗的25例儿童漂浮肘进行回顾性研究。25例儿童漂浮肘损伤病例中，男17例，女8例，平均年龄7．5岁。肱骨髁上骨折25例，GartlandⅠ型4例，Ⅱ型10例，Ⅲ型11例。桡骨骨折25例，桡骨干骨折3例，桡骨远侧干骺端骨折14例，累及桡骨远端骨骺的骨折8例，尺骨骨折11例。伴有桡神经损伤3例，正中神经损伤1例。I型肱骨髁上骨折行手法复位石膏固定，Ⅱ型、Ⅲ型的肱骨髁上骨折予以闭合复位克氏针固定，对桡骨骨折依据病理解剖的类型行骨折闭合复位克氏针固定、弹性髓内钉固定或骨折切开复位钢板内固定。结果依据修订Flynn表对治疗效果作出客观评价，22例患儿肘关节屈伸和前臂旋转的功能正常，2例患儿患侧肘关节有10°屈曲伸直受限，10°前臂旋转受限，1例患儿患侧肘关节有15°屈曲受限，伴有12°前臂旋转受限，无肘内外翻畸形。结论根据漂浮肘的病理解剖类型采用相应的治疗措施，治疗效果是满意的。

Objective To analyze the mechanisms of injury, adopt the therapeutic regimen according to the pathological anatomy, evaluate the therapeutic effects of floating elbow, and present our experience in the management of ＂floating elbow＂ in children. Methods From 2005 to 2012,25 cases （17 boys and 8 girls ） with average age of 7. 5 years were retrospectively evaluated after treatment of their floating elbow injuries. Twenty-five cases were with supracondylar fracture of the humerus,including Gartland type I in 4 patients, type II in 10 cases,and type III in 11 case. Eleven cases were with both the radius and ulna fractures, and 14 with simple radius fractures. The radius fractures included shaft of radius fractures in 3 cases,metaphysis fractures in 14 cases, and epiphyseal fractures in 8 cases. Three cases had radial nerve injury, and one case had median nerve injury. All patients with Gartland type II/III supraeondylar fractures were treated with primary dosed reduction and percutaneous Kirsehner wire pinning, while cases with type I were treated with plaster. Some patients with displaced radius fractures were treated with primary closed reduction and percutaneous Kirschner wire pinning or elastic intramedullary nail fixation. Some cases were treated with open reduction and internal fixation. Results According to the modified Flynn criteria,two patients had 10 deficiency of the range of elbow motion and 10 deficiency of forearm supination, one case had 15 limitation of elbow flexion and 12 limitation of forearm supination, and the remaining 22 cases had satisfactory elbow and forearm movements. No residual varus and valgus were found in all cases except ligament hyperlaxity. Conclusions Management of floating elbow according to the pathological anatomy is effective with satisfactory functional results.