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目的介绍采用手法闭合复位加经皮穿克氏钉治疗儿童肱骨高位髁上骨折的方法及治疗体会。方法选择2013年1月—2015年7月安徽省儿童医院骨科治疗的32例儿童肱骨高位髁上骨折患儿,均采用手法闭合复位后加直接经皮肤穿交叉克氏钉治疗,术后予以肘关节石膏托外固定4周,4周后复查摄片见骨折愈合后拆除石膏,拔钉后配合功能锻炼。结果 32例患儿分别于术后1、3、6、12个月获得随访,随访期最短3个月,最长12个月。根据术后肘关节功能恢复情况,采用Flynn肘关节评分标准:32例患儿术后经过3~12个月的随访,优26例,良5例,可1例。所有治疗均取得满意的治疗效果。患儿肘关节活动功能最短在术后1.5个月,最长在术后3个月恢复正常。32例患儿中无一例出现骨折再移位,无肘关节活动功能受限,无一例发生尺神经损伤,未出现钉尾激惹感染病例。结论闭合复位加经皮穿克氏钉可有效治疗儿童肱骨高位髁上骨折,避免传统切开复位方法所引起的手术创伤及术后疤痕的形成,可获得良好的肘关节功能。利用手法闭合复位加经皮穿克氏钉技术治疗儿童肱骨高位髁上骨折可以维持较强的骨折复位后的稳定性,手术操作简单、安全、创伤小、远期无疤痕,而且并发症少,非常值得在临床推广应用。
Objective To introduce the methods of treatment of closed supracondylar fractures of humerus with closed reduction combined with percutaneous penetration of Kirschner wire and its treatment experience. Methods From January 2013 to July 2015, 32 children with supracondylar humerus fractures treated by orthopedics in Children’s Hospital of Anhui Province were treated with closed reduction and direct crossover Kirschner wire treatment, followed by elbow Joint plaster care fixed for 4 weeks, 4 weeks after the review of the film, see the demolition of plaster after fracture healing, after pulling the nail with functional exercise. Results 32 cases were followed up at 1, 3, 6 and 12 months after operation. The shortest follow-up period was 3 months and the longest was 12 months. According to the postoperative functional recovery of the elbow, the Flynn elbow score was adopted. 32 cases were followed up for 3 to 12 months after operation, with 26 cases being excellent, 5 good and 1 fair. All treatments achieved satisfactory results. Children with the shortest elbow motion in 1.5 months after surgery, the longest in 3 months after the return to normal. None of the 32 children had fracture re-displacement, no elbow joint mobility was limited, and no ulnar nerve injury occurred. No cases of nail-tip irritation occurred. Conclusion Closed reduction and percutaneous wearing Kirschner wire can effectively treat the supracondylar fracture of humerus in children. It can avoid the surgical trauma caused by traditional open reduction and the formation of postoperative scar, and can obtain good elbow function. The use of closed reduction and percutaneous wearing Kirschner wire technology for the treatment of children with supracondylar humerus fractures can maintain a strong fracture stability after reset, the operation is simple, safe, less trauma, long-term scarless, and fewer complications, Very worthy of promotion in clinical application.