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目的 探讨儿童肱骨髁上骨折合并肱动脉损伤的受伤机制、诊断及手术治疗。方法 收治 9例肱骨髁上骨折合并不同类型的肱动脉损伤病人 ,肱动脉完全性断裂 4例 ;肱动脉被肱骨近端前下缘尖利之骨端刺破 1例 ;肱动脉节段性血栓栓塞 1例 ;肱动脉痉挛 3例。所有病人在解除血管压迫 ,探明血管损伤情况后进行骨折牵引复位。结果 术后 4～ 6周内骨折愈合 ,8例前臂血运得以良好的恢复 ,仅 1例因伤后时间长 ,术后仍发生晚期前臂缺血性挛缩。结论 儿童肱骨髁上骨折可造成肱动脉损伤 ,动脉损伤程度不一 ,若诊断治疗不及时会引起严重的前臂缺血并发症。应对可疑病人的前臂血循环进行仔细、连续动态观察 ,一旦确诊 ,手术宜早期进行。
Objective To investigate the injury mechanism, diagnosis and surgical treatment of supracondylar humerus fractures associated with brachial artery injury. Methods Nine cases of supracondylar humerus fractures with different types of brachial artery injury were treated. The brachial artery was completely ruptured in 4 cases. The brachial artery was punctured in 1 case with sharp anterior inferior border of the proximal humerus. The brachial artery segmental thromboembolism 1 case; brachial artery spasm in 3 cases. All patients were relieved of vascular compression, blood vessel damage detection after fracture traction reduction. Results Fractures were healed within 4 to 6 weeks after operation, and 8 cases of forearm blood supply recovered well. Only 1 patient had long ischemic contracture due to long time after injury. Conclusion The supracondylar fractures of the humerus can cause brachial artery injury and arterial injury to varying degrees. If the diagnosis and treatment are not timely, it may cause serious complications of forearm ischemia. The suspicious patients should be carefully forearm blood circulation, continuous dynamic observation, once diagnosed, surgery should be carried out early.