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目的探讨小切口穿针术治疗儿童Gartland Ⅲ型肱骨髁上骨折的手术方式和治疗效果。方法 2002年9月-2009年7月,收治189例儿童Gartland Ⅲ型肱骨髁上骨折。男137例,女52例;年龄1～13岁,平均6.2岁。运动伤173例,车祸伤9例,高处坠落伤5例,地震伤2例。伴其他部位骨折11例;桡神经损伤36例,正中神经损伤5例,尺神经损伤2例;肱动脉断裂2例。受伤至入院时间1h～10d。采用小切口穿针术治疗骨折,同期行神经、血管探查修复。结果术后切口均Ⅰ期愈合,无相关并发症发生。143例获随访,随访时间5个月～5年,平均12个月。X线片示骨折均愈合,愈合时间2～4个月,平均2.5个月。6例发生肘内翻,但肘关节屈伸功能基本正常;其中2例行肱骨远端楔形截骨矫形术,余继续功能锻炼。肘关节功能评价参照Flynn等临床功能评定标准:优121例,良15例,可7例,优良率95.1%。术后切口未遗留明显瘢痕,神经、血管损伤者术后功能均基本恢复正常。结论小切口穿针术治疗儿童Gartland Ⅲ型肱骨髁上骨折具有创伤小、手术时间短、操作简便、手术并发症少的优点。
Objective To investigate the surgical treatment and treatment effect of Gartland Ⅲ supracondylar humerus fractures in children undergoing small incision and needle-penetrating surgery. Methods From September 2002 to July 2009, 189 cases of Gartland Ⅲ supracondylar fractures of the humerus were treated. There were 137 males and 52 females, ranging in age from 1 to 13 years with an average of 6.2 years. There were 173 cases of sports injuries, 9 cases of car accident injuries, 5 cases of falling injuries from height and 2 cases of earthquake injuries. With other parts of the fracture in 11 cases; radial nerve injury in 36 cases, median nerve injury in 5 cases, ulnar nerve injury in 2 cases; Brachial artery rupture in 2 cases. Injured to admission time 1h ~ 10d. A small incision needle for the treatment of fractures, the same period the nerve, vascular exploration and repair. Results The incisions healed in the first stage without any complication. 143 patients were followed up for 5 months to 5 years, an average of 12 months. X-ray showed fracture healing, healing time 2 to 4 months, an average of 2.5 months. 6 cases of cubitus varus, but the elbow flexion and extension functions were normal; 2 cases of distal humeral wedge osteotomy, I continued functional exercise. Elbow function evaluation with reference to Flynn and other clinical function evaluation criteria: excellent in 121 cases, good in 15 cases, 7 cases, good rate of 95.1%. Postoperative incision did not leave significant scar, nerve, vascular injury were postoperative functional recovery to normal. Conclusion Small incision needle operation for the treatment of children with Gartland Ⅲ supracondylar humerus fractures with less trauma, shorter operative time, simple operation, fewer complications.