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作者分析了本院1993年~1996年中资料完整的儿童肱骨髁上骨折328例,主要采用闭合复位,石膏外固定306例(93.3%),按朱盛修对肱骨髁上骨折的评定标准,肘屈伸功能优良率达97.3%,但肘内翻发生率仍较高。作者认为:治疗儿童肱骨髁上骨折的首选方法为闭合整复和石膏外固定,因其保留了良好的肘关节屈伸功能。同时,作者还分析了神经、血管合并损伤的处理及时内翻的形成原因。认为:神经损伤不必早期手术探查;有血循环障碍者应及时手法复位,经2~6小时短时间观察,无好转者应及时手术探查血管。术中发现血管等软组织嵌夹于骨折端,是妨碍手法复位,影响血循环恢复的主要原因。尺偏型损伤中尺侧骨皮质的压缩、缺损是形成肘内翻的病理基础。
The author analyzed 328 cases of supracondylar humerus fractures in our hospital from 1993 to 1996, mainly using closed reduction and external fixation of gypsum in 306 cases (93.3%). According to the evaluation criteria of supracondylar fracture of humerus by Zhu Sheng-xiu, Elbow flexion and extension excellent rate of 97.3%, but the incidence of cubitus varus is still high. The authors believe that: the preferred method of treatment of supracondylar humerus fractures in children with closed repair and plaster external fixation, because it retains a good elbow flexion and extension functions. At the same time, the author also analyzed the causes of neurovascular injury and timely varus formation. That: nerve injury does not require early surgical exploration; blood circulation disorders should promptly reset, after 2 to 6 hours of short observation, no improvement should be timely surgical exploration of blood vessels. Intraoperative findings such as blood vessels and other soft tissue embedded in the fracture, is an impediment to reset, affecting the main reason for recovery of blood circulation. Skeletal segmental injury The compression and defect of the cortical bone in the medial midline are the pathological basis for the formation of cubitus varus.