闭合复位桡侧3枚克氏针固定治疗幼儿Gartland Ⅱ型及Ⅲ型肱骨髁上骨折

Closed reduction and three Kirschner pin fixation at the radial side for the treatment of supracondylar fracture in children with Gartland typeⅡand type Ⅲ

目的 ：探讨幼儿期肱骨髁上骨折的特点及闭合复位桡侧穿针固定治疗的效果。方法 ：自2010年6月至2013年6月就诊幼儿GartlandⅡ型及Ⅲ型肱骨髁上骨折35例,其中男28例,女7例;年龄1岁1个月~2岁6个月,平均2岁1个月。按Gartland分型,Ⅱ型19例,Ⅲ型16例。均为闭合性骨折,其中合并桡神经损伤3例,合并骨间前神经损伤5例,无合并血管损伤。所有患儿采用闭合复位穿针桡侧3枚克氏针固定,后行屈肘90°位石膏外固定,术后第2天复查X线片,术后2~3周后拆除石膏行肘关节屈伸功能锻炼,术后4~5周根据骨折愈合情况拆除克氏针。观察手术时间,神经恢复情况及肘关节功能。结果：患儿均获得随访,骨折均骨性愈合,末次随访采用Flynn肘关节功能评定标准评定疗效,优28例,良4例,一般1例,差2例。结论：幼儿肱骨髁上骨折采用闭合复位桡侧3枚克氏针固定,具有微创、住院时间短、克氏针取出方便及治疗效果可靠的优点。

Objective：To investigate the characteristics of supracondylar fracture of humerus in children and to explore the effect of closed reduction and internal fixation at radial side on the fracture. Methods：The children with fractures of Gart- land type Ⅱ and type Ⅲ in our hospital from June 2010 to June 2013 were reviewed. There were 28 males and 7 females ,rang- ing in age from 1 year and 1 month to 2 years and 6 months,with an average of 2 years and 1 month. According to Gartland classification, 19 cases were type Ⅱ , 16 cases were type m. There were 3 patients with radial nerve injuries, and 5 patients with anterior interosseous nerve injuries. There were no vascular injuries. All the patients were treated with closed reduction and three Kirschner fixation at the radial side ,followed by the plaster external fixation with elbowed flexion at 90 °. The X-ray ex- amination was performed at the second day after operation. The joint function exercise began about at 2 to 3 weeks after opera- tion when the plaster fixation was removed, and opportune time for removal of Kirschners depends on the situation of fracture healing. The operation time, nerve recovery, and the elbow joint function were observed. Results： All the children were followed up, and all the fractures had bony union. According to Flynn score system at the final follow-up, 28 patients got an excellent re- sult,4 good, 1 poor and 2 bad. Conclusion：Three Kirschner fixation at the radial side for the treatment of supracondylar frac- ture of humerus has advantages of minimally invasive, shorter time of hospitalization, simple removal of the internal fixation, and reliable therapeutic effects.