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目的:探讨GartlandⅣ型儿童肱骨髁上骨折微创治疗的手术技巧及疗效。方法:回顾性分析20例Ⅳ型骨折患者,其中男15例,女5例,年龄最小2.5岁,最大11岁,平均6.4岁。左侧8例,右侧12例,均为单侧骨折。手术距受伤时间最短3h,最长为96h,平均6h.20例患儿中,4例伴正中神经损伤,2例桡神经损伤,1例同时存在正中、桡神经、尺神经损伤。所有患者均为闭合复位,克氏针外侧或内外侧交叉固定,术后石膏托外固定。术后常规随访并采用Flynn肘关节评分标准判断治疗效果。结果:外侧3枚克氏针固定3例,外侧2枚加内侧1枚克氏针固定15例,内外侧各一枚克氏针1例,其中2例外侧三针固定患儿末次随访时出现轻度肘内翻畸形。手术时间为(46.8±12.4)min;术中透视(11.3±3.6)次。20例患者均获6~28个月(21.1±6.2)随访。所有患者骨折均获骨性愈合,平均影像学愈合时间为1.1~2.1个月(1.2±0.3);3例患者术后出现针道的浅表性感染,经伤口换药后伤口顺利愈合;本组病例中无医源性尺神经损伤,骨筋膜室综合征及Volkmann缺血性挛缩等并发症发生;术前1例伴有正中、桡神经、尺神经损伤症状的患者,术后7个月完全恢复。按照Flynn肘关节功能评价标准,本组优17例,良2例,可1例,优良率为95%。结论:闭合复位克氏针内固定治疗GartlandⅣ型多向不稳定儿童肱骨髁上骨折是可行的,可避免开放手术,本法具有损伤小,疗效确切,术后并发症少,肘关节功能恢复快等优点。
Objective: To investigate the surgical techniques and curative effects of minimally invasive treatment of supracondylar humerus fractures in children with Gartland type Ⅳ. Methods: A retrospective analysis of 20 patients with type Ⅳ fracture, including 15 males and 5 females, the youngest 2.5 years old, maximum 11 years old, average 6.4 years. Left in 8 cases, right in 12 cases, all unilateral fractures. The shortest operation time was 3h and the longest time was 96h. The average time was 6h. Of the 20 patients, 4 had median nerve injury, 2 had radial nerve injury, and 1 had radial, median nerve and ulnar nerve injury simultaneously. All patients were closed reduction, Kirschner wire cross or outside the lateral fixation, plaster external fixation. Postoperative follow-up and Flynn elbow scoring criteria to determine the treatment effect. Results: Three Kirschner wires were fixed on the lateral side, two on the outer side and one Kirschner wire on the inner side, and one Kirschner wire on the medial and lateral sides. One of the two cases showed fixation at the last follow-up Mild cubitus varus deformity. The operation time was (46.8 ± 12.4) min. The intraoperative fluoroscopy was (11.3 ± 3.6) times. All 20 patients were followed up for 6 to 28 months (21.1 ± 6.2). All the fractures were healed. The average imaging healing time ranged from 1.1 to 2.1 months (1.2 ± 0.3). The superficial infection of the needle path was observed in 3 cases. The wound healing was successful after the wound dressing was changed. There was no iatrogenic ulnar nerve injury, osteofascial compartment syndrome and Volkmann ischemic contracture in the group of patients. One patient had symptoms of median, radial nerve and ulnar nerve injury before operation. Seven patients Month completely restored. According to Flynn elbow function evaluation criteria, the group of excellent in 17 cases, good in 2 cases, 1 case, excellent and good rate was 95%. Conclusion: Closed reduction Kirschner wire internal fixation for the treatment of supracondylar humeral fractures in children with unstable Gartland Ⅳ type is feasible and can avoid open surgery. This method has the advantages of small injury, exact curative effect, less postoperative complications and quick recovery of elbow function Etc.