闭合复位经皮穿针法治疗儿童多向不稳定型肱骨髁上骨折

Closed Reduction and Percutaneous Pin Fixation Treating of Multidirectional Unstable Humerus Condyle Fracture in Children

目的探讨闭合复位经皮穿针固定治疗儿童多向不稳定型肱骨髁上骨折的临床疗效。方法选取2013年9月—2016年10月本组收治的多向不稳定型(GartlandⅣ型)儿童肱骨髁上骨折患儿34例作为研究对象。采用麻醉下手法整复及C臂机辅助下经皮穿克氏针固定的方法,术后定期随访,观察骨愈合情况、肘内翻发生率及肘关节功能情况。结果所有病例均复位成功,无一例采用切开复位,所有34例随访6~18个月,平均(8.5±1.6)个月,均达骨性愈合,治疗及随访期间未发现针眼感染、Volkmann挛缩、骨化性肌炎,Flynn评分标准,优30例,良4例,总优良率100%。结论闭合复位经皮穿针固定治疗儿童多向不稳定型肱骨髁上骨折创伤小、愈合快、功能恢复好,符合小儿骨科治疗原则,熟练的团队配合是术中操作成功的关键。

Objective To evaluate the clinical effcacy of closed reduction and percutaneous pinning for the treatment of children from unstable supracondylar fractures of the humerus. Methods From September 2013 to October 2016, 34 children with humeral supracondylar fracture of multidirectional instability （Gartland type IV） were enrolled in this study. The technique of manual reduction under anesthesia and percutaneous Kirschner wire fixation under C arm machine was adopted, regular follow-up after operation, the union of bone, the incidence of cubitus varus and the function of elbow joint were observed. Results All cases were reset successfully, no case with open reduction, all 34 cases were followed up for 6 to 18 months, the average follow-up time was （8.5±1.6） months, all patients achieved bony healing, needle infection, Volkmann contracture, myositis ossificans was found during the treatment and follow-up of Flynn, standard for evaluation, excellent in 30 cases, good in 4 cases, the total excellent rate was 100%. Conclusion Closed reduction and percutaneous pinning for the treatment of children from unstable supracondylar fracture of the humerus in small trauma, quick healing, good function recovery. In accordance with the principle of pediatric department of orthopedics treatment, skilled team cooperation is the key to successful operation.