驱血带辅助下经皮外侧克氏针固定治疗青少年GartlandⅢ型肱骨髁上骨折

Percutaneous Lateral Cross Kirschner Wires Fixation Assisted by Tourniquet for Humeral Supracondylar Fracture with Gartland TypeⅢin the Adolescents

目的探讨驱血带辅助下桡侧克氏针固定治疗青少年GartlandⅢ型肱骨髁上骨折的疗效。方法回顾性分析2016年9月~2018年3月收治的23例青少年GartlandⅢ型肱骨髁上骨折患者的临床资料,均为闭合性骨折,其中男14例,女9例,平均年龄12.4(10~15)岁。均行骨折端复位,驱血带维持肱骨远端复位,闭合复位经皮桡侧克氏针固定,术后长臂管型石膏固定4周,拆除石膏后进行肘关节屈伸功能锻炼。术后采用Flynn肘关节评分评估临床疗效。结果本组23例患儿均顺利完成闭合复位经皮桡侧克氏针固定,手术时间平均44(31~55)min。平均随访15.3(13~22)个月,所有患儿均获得骨性愈合,无一例出现血管神经损伤或克氏针断裂等并发症。末次随访未见肘内翻畸形,按Flynn功能评定标准:优22例,良1例,优良率100%。结论驱血带辅助下桡侧克氏针固定创伤小、复位稳定、肘内翻发生率低、医源性尺神经损伤少,是治疗青少年GartlandⅢ型肱骨髁上骨折的有效方法。

Objective To expore the effect of fixation of percutaneous lateral cross Kirschner wires under tourniquet for humeral supracondylar fractures with Gartland typeⅢin adolescents.Methods The clinical data of 23 adolescents with closed typeⅢhumerus supracondylar fractures from September 2016 to March 2018 were analyzed retrospectively,including 14 of male and 9 of female,and aged from 10 to 15(mean,12.4)years old.The treatment of closed reduction and percutaneous lateral cross Kirschner wires fixation was performed under tourniquet,and above-elbow plaster cast was used for four weeks.The clinical effect was assessed by Flynn elbow functional score.Results All surgery were accomplished with the average operation time of 44 minutes(ranged 31 to 55 minutes).All fractures achieved bone union during the 13 to 22 months follow-up period.There was no iatrogenic neurovascular injuries,Kirschner wires broken and cubitus varus.Base on the criteria of Flynn,the elbow function showed excellence in 22 cases,good in 1 case,and the fineness rate was 100%.Conclusion The fixation of percutaneous lateral cross Kirschner wires assisted by tourniquet is a effect surgery for humeral supracondylar fracture with Gartland typeⅢin adolescents with mini-trauma,stable reduction,low incidence of cubitus varus and less injury of ulnar nerve.