肱骨髁上骨折患儿的外侧小切口切开复位治疗

An investigation on surgical indications of humeral supracondylar fracture in children: open reduction through small lateral incision

目的探讨切开复位克氏针固定治疗肱骨髁上骨折患儿的疗效。方法回顾性分析2009年9月至2015年12月于本院接受切开复位手术治疗的31例儿童肱骨髁上骨折的临床资料,其中男18例,女13例,年龄11个月~14岁,平均4.5岁。受伤至手术间隔时间为10 h^13天,平均1.8天。均采用肱骨远端外侧入路切开复位,直视下克氏针内固定术,术后支具功能位外固定。术后3、6、12、18、24、30个月时采用Flynn肘关节评分标准评定疗效。结果本组均获得随访,资料完整,随访12~30个月,平均24.6个月。闭合复位失败者23例;开放骨折者4例;合并神经损伤者4例。本组病例平均手术时间为38.2(30~48)min,术中出血平均20.8(15~40)ml,平均住院日6.2(4~15)天。按照Flynn肘关节临床功能评分标准评定疗效:术后3个月优良率为74.2%(23/31),术后12个月优良率为96.8%(30/31),其中1例肘关节屈伸活动度减少>15°。术后患儿均未出现伤口不愈合、骨筋膜室综合征、血管损伤、神经损伤、骨折不愈合、肘关节内、外翻畸形等并发症。结论外侧小切口切开复位治疗儿童肱骨髁上骨折疗效确切。该方法操作相对简单,手术风险小、时间短,对患儿创伤小,并发症少,可以有效治疗上述类型的肱骨髁上骨折。

Objective To investigate the surgical indications and use of Kirschner wire in the fixation of open reduction by small lateral incision on Children＇s humeral supracondylar fracture by following up the cases in recent years. Methods From September 2009 to December 2015, 459 cases of children with humeral supracondylar fracture were analyzed retrospectively, in which 31 cases （ 6.8% of all the cases ） were treated in open reduction. There were 31 cases （ 18 male and 13 female cases aged from 11 months to 14 years, 4.5 years on average ）, and the time interval from injury being from 10 hours to 13 days （ 1.8 days on average ）. All patients were treated with open reduction by lateral incision of distal humerus with Kirschner wires and brace was used in functional position after surgery. Clinical effects were assessed by Flynn standard in 3, 6, 12, 18, 24 and 30 months. Results All the 31 cases were followed up from 12 to 30 months （ 24.6 months on average ） with complete data, of whom 23 cases failed in close reduction, 4 cases were of open fractures, 4 cases had combined nerve injuries. The average surgery time was 38.2 minutes （ range： 30 - 48 minutes ）, the average intraoperative blood loss was 20.8 ml （ range： 15 - 40 ml ）, and the average hospital stay was 6.2 days （ range： 4 - 15 days ）. According to the Flynn standard of joint function, the effects were ＂good＂in 74.2% （ 23 / 31 ） of the cases in 3 months postoperatively, and in 96.8% （ 30 / 31 ） in 12 months postoperatively, in whom the decrease of joint flection-extension motion was larger than 15° in 1 case. No unhealed wounds, osteofascial compartment syndrome, vascular injury, nerve injury, fracture disunion, cubitusvarus and valgus deformity or other complications were found in any case. Conclusions Open reduction of small lateral incision is effective on children＇s humeral supracondylar fracture with simple operation, less surgical risk, shorter operation time, less trauma and complications.