伸直位石膏夹板固定治疗儿童肱骨髁上骨折

Treatment of humeral supracondylar fracture in children with external plaster fixation on extension position

目的 :探讨非手术治疗儿童肱骨髁上骨折预防肘内翻畸形的有效方法。方法 :自1992年5月至2013年12月,采用手法复位伸直位石膏夹板外固定治疗无神经血管损伤的儿童肱骨髁上骨折319例,男253例,女66例;年龄1岁3个月~13岁,平均6.7岁。伸直型肱骨髁上骨折284例,屈曲型肱骨髁上骨折35例。左侧167例,右侧152例。受伤至治疗时间1 h^7 d,平均1.8 d。不包括神经血管损伤病例及手术病例。结果 :所有患者获得随访,时间3个月~14年,平均37.3个月。所有患儿获得骨性愈合,骨折愈合时间6~8周,平均6.9周。无严重肘内翻畸形、血管神经损伤或Volkmann挛缩等并发症发生。183例提携角与自身健侧一致,在5°~15°范围内,105例提携角较自身健侧有不同程度的减小,26例在复位时即有尺偏者提携角在-5°~0°,5例在复位时即有桡偏者提携角在15°~18°,基本不影响外观。所有病例肘关节活动度正常。结论:肘关节伸直位石膏夹板固定对预防儿童肱骨髁上骨折非手术治疗后的肘内翻畸形具有一定价值,希望有更多学者做进一步的研究。

Objective：To explore the effective method of preventing cubitus varus deformity in nonoperative treatment of humeral supracondylar fracture in children. Methods：From May 1992 to December 2013,319 patients with hemeral supracondylar fracture in children were treated with manual reduction and external plaster fixation in extension position. There were253 males and 66 females,aged from 15 months to 13 years old with an average of 6.7 years. Among the patients with humeral supracondylar fracture,extension type was in 284 cases and inflexion type was in 35 cases;167 cases on the left and 152 cases on the right. Injury to treatment time was 1 hour to 7 days with a mean of 1.8 days. No included nerve injury and operative case in the patients. Results：All patients were followed up from 3 months to 14 years with an average of 37.3 months. All fractures obtained bone healing and healed time was 6 to 8 weeks with an average of 6.9 weeks. No complications of serious cubitus varus deformity,vascular nerve injury or volkmann contracture were found. In 183 cases,the carrying angle was consistent with itself contralateral,ranged from 5 ° to 15°; in 105 cases,the carrying angle of uninjuryed side was decreased. During the reset,the carrying angle of 26 patients with ulnar deviation angle was for-5° to 0°;and 5 patients with radial deviation angle was for 15° to 18°,basically does not affect the appearance. The activities of all elbow joint were normal. Conclusion：External plaster fixation in extension position has some value to preventing cubitus varus deformity in nonoperative treatment of humeral supracondylar fracture in children and hope that more scholars to do further study.