皮外张力固定治疗肱骨髁上骨折疗效观察

The Treatment of Humeral Supracondylar Fracture by Extracutaneous-Tension Fixation

目的 探讨和总结儿童肱骨髁上骨折理想的手术治疗方法。方法 取肘关节外侧切口,经外上和外下穿针交叉内固定,皮外针尾张力相挂,使外侧持续加压固定治疗儿童肱骨髁上骨折23例。结果 对23例病人经6个月～2年,平均18个月的随访,治愈18例,好转4例,未愈1例,治愈好转率95.6％。固定模式经力学测试:直径2 mm、弹性模量0.15 Gpa的克氏针,在距骨皮质外3 cm处折弯,间距0.7 cm时张力相挂,对折端外侧有65 N的挤压力,内侧有10 N的牵开力。结论 外侧切口、皮外张力固定治疗儿童肱骨髁上骨折有利于骨折愈合和关节功能恢复,并可预防肘内翻畸形,是一种较理想的治疗方法。

Objective To explore and sum up the rational mode of the operative fixation for children's humeral supracondylar fracture (HSF). Methods Twenty-six cases of HSF were treated by extracutaneous-tension fixation (ETF). The fixation was made through a lateral-elbow incision with two Kirschner pins, one of which was inserted laterosuperiorly and the other lateroinferiorly as to cross each other for internal fixation and hooked each other with their extracutaneous ends as to cause tension. Results Through the follow-up (Range: 6 to 24 months; Mean: 18 months), the results included 18 cases cured, 4 improved and one non-cured; and the cured-im-proved rate reached 95.6 % . The mechanical assay of the fixation mode showed: (1)the Kirschner pins (2 mm in diameter and 0.15 Gpa in elastic modulus) were bent at the point 3 cm lateral to the cortex and hooked each other at an interval of 0.7 cm to cause tension) (2) a squeezing force of 62 N was produced on the lateral side of the fragment; (3)and a retraction force of 10 N was produced on the internal side. Conclusion Used to treat HSF, ETF benefits to the fracture healing and the joint-function recovery and functions to prevent cubi-tus varus, being a rational fixing method.