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目的探讨儿童GartlandⅢ型肱骨髁上骨折(Supraondylar fracture of humerus,SFH)内固定治疗的方法与术后康复策略。方法 2009年1月至2011年11月在我院骨科闭合复位治疗失败后的GartlandⅢ型SFH患儿23例,采用小切口联合入路(肘外侧+内侧)交叉穿针或外侧穿入2～3根针固定,术后按软组织恢复期分阶段指导功能锻炼,经临床检查及X射线随访,统计肘内翻、骨化性肌炎及关节僵硬的发生情况,功能评价标准采用改良美国特种外科医院(HSS)肘关节功能评分系统。结果 1例患儿(就诊时间>9天)发生左前臂坏死转上级医院行截肢术,其余22例改良评分优12例、良6例、可2例、差2例,优良率为81.82%。23例全部获得随访,随访时间3～16个月,平均5.6个月。2例患儿出现神经损伤,1个月后均自行恢复;1例患儿遗留屈曲挛缩畸形,致伸肘在120°以内;3例患儿遗留肘内翻畸形,但肘关节功能良好;2例患儿发生骨化性肌炎。结论儿童GartlandⅢ型SFH的治疗极具挑战性,伤后及时就诊及手术、术中精确复位与可靠固定、术后正确的指导功能锻炼常可获得良好预后;延迟手术、反复闭合复位及术后被动牵拉是影响患儿预后的重要因素,应注意避免。
Objective To investigate the methods and postoperative rehabilitation strategies for the treatment of Gartland type Ⅲ supracondylar fractures of the humerus (Supraondylar fracture of humerus, SFH) in children. Methods From January 2009 to November 2011, 23 children with Gartland type Ⅲ SFH after orthopedic closure failure in our hospital were treated with small incision and combined approach (lateral to lateral + medial) According to the clinical examination and X-ray follow-up, the incidence of cubitus varus, myositis ossifying and joint stiffness were measured. The functional evaluation criteria were evaluated by the American Specialized Surgery Hospital (HSS) elbow function scoring system. Results One case (treatment time> 9 days) had anterior left arm necrosis and transferred to the superior hospital for amputation. The remaining 22 patients had excellent result in 12 cases, good in 6, fair in 2 and poor in 2, the rate of excellent and good was 81.82%. All 23 cases were followed up for 3 ~ 16 months with an average of 5.6 months. 2 cases of children with nerve injury, 1 month after the recovery on their own; 1 case of left flexion contracture deformity, resulting in elbow extension within 120 °; 3 cases left elbow varus deformity, but the elbow function well; 2 Cases of children with ossifying myositis. Conclusion The treatment of children with Gartland type Ⅲ SFH is very challenging. The patients are treated promptly after operation and are accurately reset and reliably fixed during operation. Correct postoperative functional training often leads to good prognosis. Delayed operation, repeated closed reduction and postoperative passive Pulling is an important factor affecting the prognosis of children, should be avoided.