肱骨髁上骨折旋转移位整复角度量化的初步研究——附16例分析

A PRELIMINARY STUDY ON THE ANGLES OF CLOSED REDUCTION FOR THE ROTARY DISPLACEMENT OF UPRACONDYLAR HUMERUS FRACTURE AND ANNALYSIS OF 16 CASES OF CLINICAL APPLICATION

为探索手法整复肱骨髁上骨折旋转移位时控制旋转角度的方法。根据肱骨下段宽阔而且扁平的结构特点 ,将 2 5张成人正常肱骨标准侧位 X线片、11张儿童正常肱骨标准侧位 X线片、16具成人正常上肢骨骼标本、8例肱骨髁上骨折患儿手术时的上肢骨骼 ,按年龄分为成人组和儿童组。对肱骨下段背面进行观察 ,并且测量 :1肱骨长轴和肱骨下段背面的夹角 ;2屈肘 90°位尺骨长轴和肱骨下段背面与横切面交线的垂线之间的夹角。结果发现 ,肱骨下段背面通常近似一平面 ,上述 2种夹角的角度在成人与儿童间数值差异无显著性 (P>0 .0 5 )。表明肱骨下段背侧平面确实存在 ;肱骨长轴和肱骨下段背面的夹角以及在屈肘 90°位尺骨长轴和肱骨下段背面与横切面交线的垂线之间夹角的角度均较恒定。根据上述肱骨下段的解剖特点设计出屈肘位定量内摆前臂法 ,并以此矫正传统手法整复失败的 16例患者的旋转移位 ,一次复位成功 13例 ,占 81.3% ,且无神经血管损伤。

To explore the angles of closed reduction for the rotation displacement of supracondylar fracture of humerus. Methods: On basis of that the humerus is wide and flat at the distal, 16 skeletal specimens of adult's upper extremities, 8 children′s upper limb which were having an operation on supracondylar fracture of humerus, 25 adults′and 11 children′s normal humerus standarded lateral radiographs, all the above subjects were allocated into adult group or children group, according to age. Observation of the dorsal aspect of distal humerus was performed. An angle between the dorsal aspect and the long axial line of humeral shaft, and on transverse section of humerus with the elbow in 90 degrees of flexion, another angle between the dorsal aspect and the long axial line of ulna, were measured. Results: Generically, the dorsal aspect of distal humerus was able to be regarded as a plane. The degrees of the two angles in adult group were not significantly different from those in children group(P>0.05). Conclusions: The dorsal 'plane' of distal humerus was really existing. The degree of the angles between the plane and the long axial line of humerus shaft or ulna in a certain position was relatively stable. It was a worthy anatomical structure. In the light of the findings, a new technique of 'mediad swinging the forearm quantitatively with the elbow as axis, whilst in 90 degrees of flexion' was designed, 16 cases of supracondylar fracture of humerus, which were still in severe rotation displacement after several times of traditional closed reduction, were treated with the new closed reduction. Thirteen of those were reduced at once , the rate was 81.3%, and no neurovascular injury happened. It was suggested that the new closed reduction was more effective than the traditional one .