手法整复与经皮钢针内固定治疗儿童Gartland Ⅲ型肱骨髁上骨折1 100例

Treatment of supracondylar fractures of the humerus in children with manipulative closed reduction and improved percutaneous kirschner wire inter-fixation for 1 100 cases

目的：通过观察分析利用“定位针”、“防旋针”治疗儿童肱骨髁上骨折的优势与疗效，探讨一种改良的经皮钢针内固定治疗方法。方法本组1100例 GartlandⅢ型儿童肱骨髁上骨折，均在 C型臂 X 线透视下行手法复位骨折端，先自肱骨远端尺骨鹰嘴外侧向肱骨髓腔方向打入“定位针”，再自肱骨外髁向内上方斜向打入“防旋针”固定骨折端。术后石膏托固定，3～4周后去除内外固定进行功能锻炼。结果本组病例均获随访，骨折均在术后3～5周愈合，平均时间为3.6周。参照 Flynn 等[1]临床功能评定标准，优921例，良107例，一般54例，差18例。优良率93.69％。结论闭合复位与经皮钢针内固定治疗儿童肱骨髁上骨折操作方便，安全性高，有利于术后骨折愈合及功能康复，值得临床推广。

Objetive Probe into the advantage and efficacy of a kind of improved percutaneous Kirschner wire inter-fixation method called“positioning pin”and“anti-rotation pin”for the Supracondylar fracture of the humerus in children,and promot and apply in clinical.Methods 1 100 cases of humeral supracondylar frac-tures in children were type of Gartland Ⅲ.These fractures were treated with manipulative closed reduction with the C arm X-ray machine.Then we used two Kirschner wires.Firstly,a 2 mm “positioning pin”was drived into the humeral medullary cavity in the distal end of the humerus,ulna olecranon outside;then,a 1.5 mm or 2 mm “anti-rotation pin”was drived from the external condyle of humerus inward to medial epicondyle of hu-merus.Postoperatively elbow was fixed with plaster external fixation,3 ~4 weeks later,removing internal and external fixation and functional exercise. Results All patients were followed up.The average healing time of these fractures was 3.6 weeks.Reference to Flynn clinical functional assessment standards：excellent in 921 cases,good in 107 cases,general in 54 cases,poor in 18 cases.The excellent and good rate was 93.69%. Conclusions Treatment with manipulative closed reduction and improved percutaneous Kirschner wire inter-fix-ation for supracondylar humeral fractures in children has the advantage of easy operation,high safety,and con-ducive to fracture healing and functional recovery after surgery.It is worthy of promotion in clinical.