闭合复位与经皮桡侧交叉克氏针固定治疗儿童肱骨髁上骨折

Closed reduction and percutaneous radial crossed pinning of supracondylar fractures of the humerus in children

目的：评价闭合复位、经皮桡侧交叉克氏针固定治疗儿童肱骨髁上骨折的临床效果。方法2007年2月至2015年2月笔者收治肱骨髁上骨折患儿467例，其中 GartlandⅡ型87例，Ⅲ型380例；伸直型445例，屈曲型22例。患儿年龄1岁1个月至11岁7个月（平均5.6岁）。均采用闭合复位、经皮桡侧交叉克氏针固定治疗，在静脉麻醉下和“C”型臂透视下，先行闭合整复骨折，然后经皮桡侧交叉穿入2～3枚克氏针固定。结果467中，434例获随访，随访时间6～60个月（平均为25.9个月）。根据功能标准评价：优402例，良22例，可10例，差0例，优良率97.7％；根据美观标准评价：优396例，良24例，可13例，差1例，优良率为96.8％。随访时无一例发生 Volkmann 挛缩、肘内翻畸形及尺神经损伤。结论儿童肱骨髁上骨折采用闭合复位、经皮桡侧交叉克氏针固定治疗，能减少尺神经损伤、肘内翻畸形及 Volkmann 挛缩等并发症，无切口，美观，创伤小，住院时间短，肘关节功能恢复良好，临床效果良好，是一种较好的治疗Ⅱ型、Ⅲ型儿童肱骨髁上骨折的方法，值得推广。

Objetive To explore the outcomes of displaced supracondylar fractures of the hume-rus. Methods From February 2007 to February 201 5,467 children of displaced supracondylar fractures of the humerus were recruited.The clinical Gartland types were Ⅱ （n =87）and Ⅲ（n =380）.There were exten-sion （n =445 ）and flexion （n =22）types.All cases underwent close reduction and percutaneous radial crossed-pin fixation under C-arm guidance.Their mean age was 5.6 （1 .1 ~1 1 .6）years at the time of initial injury.The average follow-up period was 25.9 （6 ~60 ）months. Results A total of 434 patients were checked for function and deformity.There was no onset of cubitus varus,ulnar nerve injury or Volkmann＆#39;s con-tracture during follow-ups. Conclusions Closed reduction and percutaneous radial crossed-pin fixation is as effective as traditional cross-wire technique in terms of fracture healing with a reduced risk of ulnar nerve inju-ry.It is ideal for Gartland typesⅡand Ⅲ supracondylar fractures of the humerus in children.