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目的:探讨手法整复Ⅰ型肱骨小头骨折的动作要点及纸夹板体系固定特点。方法:自2000年4月至2008年2月手法治疗Ⅰ型肱骨小头骨折27例,男23例,女4例;年龄5～14岁,平均8.9岁;病程1～23h,平均5.4h。术前患肘均肿胀、功能障碍。X线片示肱骨小头骨折块不同程度分离、翻转移位。整复时找到正确的复位着力点,整复动作准确、连贯、稳定并配合前臂及肘关节的被动动作,屈肘90°以纸夹板体系固定。所有患者以JOA肘关节功能评价法进行功能评分。结果:27例均获随访,时间6个月～2年,平均17个月。肘关节均无痛,活动度、功能均正常,肘关节均无动摇性。整复后未出现并发症。25例断端达到或接近解剖对位愈合,2例出现轻度肘外翻畸形。JOA评分100分25例,97分2例。结论:手法整复屈肘90°纸夹板外固定治疗Ⅰ型肱骨小头骨折稳定性强、成功率高、固定牢固、轻便且不会出现组织压疮及坏死。
OBJECTIVE: To explore the main points of operation and the fixation characteristics of paper splint system in manipulating type Ⅰ humeral head fractures. Methods: From April 2000 to February 2008, 27 cases of type Ⅰ humeral head fractures were treated by hand method. There were 23 males and 4 females, aged from 5 to 14 years (average 8.9 years). The course of disease ranged from 1 to 23 hours (mean, 5.4 hours). Preoperative elbow swelling, dysfunction. X-ray showed fractures of the humeral head fractures to varying degrees, flip shift. Finishing the right time to find the reset point, the whole recovery action accurate, coherent, stable and with the forearm and elbow passive action, elbow 90 ° to the paper splint system. All patients were scored by JOA Elbow Function Evaluation. Results: All 27 patients were followed up for 6 months to 2 years with an average of 17 months. Elbow pain, activity, function are normal, the elbow are not shaken. After the complication did not appear. Twenty-five patients reached or were close to the anatomical site for healing, while 2 patients had mild valgus deformity. JOA score 100 points in 25 cases, 97 points in 2 cases. Conclusion: The manipulation of 90 ° elbow flexion splint external fixation for treatment of type Ⅰ humeral head fractures with strong stability, high success rate, firm fixation, light and will not appear tissue pressure ulcers and necrosis.