两种手术方法治疗儿童重度肱骨髁上骨折的疗效比较

目的比较两种手术方法治疗儿童重度肱骨髁上骨折的疗效。方法将110例肱骨髁上骨折患者随机分为改良组和对照组各55例,改良组内外侧联合小切口克氏针钢丝张力带内固定,对照组交叉克氏针内固定,观察两组术后疗效。结果改良组平均骨折愈合时间比对照组提前15 d,肘关节功能恢复较好,并发症发生率较少,两组比较差异有统计学意义(P<0.05)。结论肘内、外联合小切口克氏针钢丝张力带固定较传统手术方式好,是治疗肱骨髁上骨折的一种有效方法。     

改良张力带钢丝治疗肱骨髁上骨折的生物力学研究及其临床应用

目的 应用自行设计改良张力带钢丝内固定技术治疗小儿肱骨髁上骨折。方法 对11侧人工肱骨髁上骨折标本应用改良张力带钠丝与交叉克氏针固定后，进行相关的生物力学测试。临床治疗肱骨髁上骨折患儿46例，随访6－78个月，平均38个月。结果 生物力学试验测试结果显示改良张力带钢丝的桡侧绑结可使骨折端产生压应力，固定强度明显优于交叉克氏针。临床随访显示骨折愈合佳，功能活动好，术后并发症发生率低。结论 改良张力带钢丝内固定治疗肱骨髁上骨折的效果明显优于克氏针交叉内固定，其稳定性允许废弃外固定，并能早期活动肘关节，是一种更符合生物力学原理的技术，值得临床推广应用。     

克氏针张力带钢丝内固定治疗儿童肱骨髁上骨折

目的:探讨儿童肱骨髁上骨折的治疗方法及克氏针"8"字张力带钢丝固定治疗儿童肱骨髁上骨折的临床效果。方法:取肘后切口,行双"8"字张力带钢丝克氏针交叉内固定治疗儿童肱骨髁上骨54例,骨折类型全部为闭合性伸直型损伤。结果:按陆裕朴[1]评定标准,优良率96%,结论:"8"字张力带钢丝克氏针交叉内固定治疗儿童肱骨髁上骨折,固定牢靠,关节功能恢复好,是治疗小儿肱骨髁上骨折的有效方法。     

张力带在儿童肱骨髁上骨折治疗中的应用

目的：评估克氏针钢丝张力带治疗儿童肱骨髁上骨折的临床效果。方法：本组患儿98例,男72例,女26例,年龄3岁～14岁。采用肘外侧或肘后正中切口,清理骨折断端,直视下复位,2枚克氏针交叉固定,1枚钢丝8字缠绕固定于桡侧的两个针尾。结果：98例患儿经6月。3年的随访,骨折一期愈合,肘关节功能正常,无肘内、外翻发生。结论：克氏针钢丝张力带内固定方法操作简便,固定可靠,能有效的防止肘内翻畸形的发生,是治疗儿童肱骨髁上骨折较为理想的方法。     

外侧小切口克氏针钢丝张力带固定治疗儿童重度肱骨髁上骨折

目的介绍采用外侧小切口克氏针钢丝张力带固定治疗儿童重度肱骨髁上骨折的方法及临床疗效。方法采用该方法治疗儿童重度肱骨髁上骨折48例。结果随访4～73个月,平均36个月。本组骨折复位良好,骨折全部愈合,功能恢复良好,1例轻度肘内翻(小于5°)。结论外侧小切口克氏针钢丝张力带固定治疗儿童重度肱骨髁上骨折,手术创伤小,并发症少,固定牢固,肘关节功能恢复良好。     

肱三头肌两侧入路克氏针张力带治疗肱骨髁上骨折

目的探讨采用肱三头肌两侧入路交叉克氏针加两侧钢丝张力带治疗肱骨髁上骨折的疗效。方法对16例肱骨髁上骨折患者采用肱三头肌两侧入路交叉克氏针加两侧钢丝张力带固定。结果12例获得随访,时间2-41个月。骨折均愈合,功能恢复完全正常11例,轻度受限1例。结论肱三头肌两侧入路结合交叉克氏针加两侧钢丝张力带内固定治疗肱骨髁上骨折,手术创伤小,操作简便,术后可早期活动,值得在基层医院推广。     

张力带法治疗陈旧性肱骨外髁骨折18例

我科自1990年12月一1995年12月,应用手术复位、克氏针交叉加10号丝线或克氏针交叉加钢丝张力带内固定治疗儿童陈旧性旋转移位型肱骨外髁骨折18例.结果表明,骨折均在2—3个月内愈合,内固定确     

两种方法治疗儿童GartlandⅢ型肱骨髁上骨折的Meta分析

目的 通过Meta分析比较闭合复位经皮克氏针内固定与切开复位克氏针内固定治疗儿童GardandⅢ型肱骨髁上骨折的疗效.方法 通过检索关于儿童GartlandⅢ型肱骨髁上骨折经皮克氏针内固定与切开复位克氏针内固定对照研究的4篇文章,采用循证医学Meta分析法对肘关节功能、提携角、术后并发症进行综合分析.结果 Meta分析发现,经皮克氏针内固定与切开复位克氏针内固定治疗儿童GartlandⅢ型肱骨髁上骨折在肘关节功能、提携角、术后并发症方面并无明显统计学差异.结论 儿童GartlandⅢ型肱骨髁上骨折首选闭合复位经皮克氏针固定,当闭合复位失败或伴有神经、血管损伤时可采用切开复位内固定治疗.     

早期截骨张力带固定治疗尺偏型肱骨髁上骨折

肱骨髁上骨折是儿童常见的骨折,而肘内翻却是儿童肱骨髁上骨折常见的并发症.据文献报告发生率最高达57%,平均约30%,尺偏型发生率更高.本院从1998年4月以来,采用早期楔形截骨克氏针张力带固定治疗儿童肱骨髁上骨折.     

儿童严重不稳定型肱骨髁上骨折的治疗体会:附Gartland Ⅳ型8例报道

目的 探讨严重移位的、屈曲及伸直位均不稳定的小儿肱骨髁上骨折Gartland Ⅳ型治疗。方法 对2008 年3月～2010年8月我院收治的8 例儿童严重的Gartland Ⅳ型肱骨髁上骨折的手术治疗疗效进行评价,分析此类型小儿肱骨髁上骨折手法复位失败的原因和切开复位克氏针固定的治疗效果。结果 8例Gartland III型肱骨髁上骨折患儿均接受切开复位及克氏针内固定术,早期进行肘关节功能锻炼,总体效果良好。随访1～3年,无一例发生骨不连,肘内翻,神经损伤。结论 Gartland III型肱骨髁上骨折切开复位仍是主要治疗手段。同时,早期进行肘关节功能锻炼,是提高本种类型骨折治疗疗效、防止肘内翻畸形发生的关键。     

双张力带结合双钩状克氏针治疗肱骨髁间粉碎性骨折

目的：探讨使用双张力带结合双钩状克氏针治疗肱骨髁间粉碎性骨折的临床疗效。方法：自2005年2月～2008年2月使用双张力带结合双钩状克氏针治疗肱骨髁间粉碎性骨折42例。结果：随访时间6月～18月,所有骨折均连接,愈合时间为3．5月～6月。利用改良Cassebaum评分系统评定肘关节功能,优良率76．2％（32／42）。结论：采用双张力带结合双钩状克氏针的固定方法治疗肱骨髁间粉碎性骨折是一种有效的方法。     

关节外侧小切口治疗肱骨髁上骨折

目的：探讨肘关节外侧入路小切口克氏针钢丝内固定治疗肱骨髁上骨折的临床效果。方法：肱骨髁上骨折58例,男42例,女16例;年龄3～65岁,平均9.4岁。均采用经肘关节外侧入路小切口4～5cm,经肱三头肌外侧与肱桡肌间隙进入。手法复位后,2枚克氏针经皮穿入外髁部,在骨折近端内侧骨皮质穿出,在骨折近端距骨折线2～3cm,外侧垂直钻孔后,穿钢丝交叉绕于肱骨外侧的克氏针尾,呈“8”字形外侧钢丝固定。结果：术中骨折达到准确复位,固定可靠。58例经随访1～5年,平均2.4年,依据Flynn临床功能评定标准：优48例,良6例,可3例,差1例。结论：肘关节外侧入路小切口克氏针钢丝内固定治疗肱骨髁上骨折创伤小、简便易行、手术时间短、固定可靠、可早期进行功能锻炼,术后肘关节功能恢复快。     

Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children

The authors assessed whether a period of 3 weeks, rather than the commonly used 6 weeks, of smooth Kirschner wire fixation and cast immobilization of the elbow was sufficient to achieve union of displaced fractures of the lateral humeral condyle treated by open reduction. The authors found only one nonunion in a case series of 104 children treated with 3 weeks of fixation. Infections occurred in two children (2%). Late review of 63 children (61%) showed abnormalities of elbow shape in 28 (44%) and wide surgical scars in 43 (68%). The abnormalities of elbow shape were mainly due to overgrowth of the lateral humeral condyle, to the formation of excessive amounts of bone over the outer surface of the condyle, or both. The authors' findings indicate that a period of 3 weeks of smooth Kirschner wire fixation and elbow immobilization is sufficient to achieve healing in most displaced fractures of the lateral humeral condyle treated by open reduction. The findings also indicate that new strategies are needed to reduce the occurrence of overgrowth of the lateral condyle, excessive formation of bone over the condyle, and wide scars.     

改良穿针并外张力带固定治疗GartlandⅢ型儿童肱骨髁上骨折

目的:探讨改良穿针并外张力带固定治疗GartlandⅢ型儿童肱骨髁上骨折的临床疗效。方法:自2009年2月至2010年11月采用肘外侧切口、改良穿针(内外髁交叉并外髁辅助穿针)并外侧外张力带固定(交叉针尾相互钩绕)法治疗GartlandⅢ型儿童肱骨髁上骨折79例,其中男47例,女32例;年龄2.5～14岁,平均8.7岁。受伤至手术时间2h～8d。记录手术前后肘关节活动度及提携角,按照Flynn评定标准评定疗效。结果:61例获得随访(18例失访),时间6～30个月,平均13.5个月。根据Flynn评定标准:优53例,良7例,可1例。结论:采用外侧小切口复位后行改良穿针并外侧外张力带固定治疗儿童肱骨髁上骨折具有固定牢固、恢复快、并发症少的特点,是治疗儿童肱骨髁上骨折较理想的方法之一。     

儿童肱骨外髁骨折的治疗体会

目的总结儿童肱骨外髁骨折的治疗效果。方法 35例JakobⅠ~Ⅲ度儿童肱骨外髁骨折患儿中,8例(Ⅰ度)采用石膏托外固定治疗,27例(Ⅰ度8例、Ⅱ度11例、Ⅲ度8例)采用切开复位克氏针内固定治疗。结果手术治疗的27例获11个月~5年随访,骨折均骨性愈合;根据Hardacre评分:优17例,良8例,差2例,优良率为25/27。非手术治疗的8例获11个月~2年随访,骨折均骨性愈合;根据Hardacre评分:优6例,良2例,优良率为8/8。结论儿童肱骨外髁骨折手术或非手术治疗均可获得较满意效果。如行非手术治疗,必须严密观察,一旦发现骨折移位应早期手术治疗。     

切开内固定治疗儿童肱骨外髁陈旧性骨折

目的探讨传统克氏针与可吸收螺钉治疗儿童肱骨外髁陈旧性骨折的疗效。方法回顾性分析2004年9月~2006年9月收治的儿童肱骨外髁陈旧性骨折20例,8例采用克氏针、12例采用可吸收螺钉内固定。结果平均随访1.2(1~1.5)年,疗效评定:优19例(克氏针固定7例,可吸收螺钉固定12例);可1例(克氏针固定)。结论可吸收螺钉治疗儿童肱骨外髁陈旧性骨折效果好,值得推广。     

Minimal osteosynthesis of fractures of the head of the humerus. Indications, technic, results

Between 1983 and 1987 minimal osteosynthesis for proximal humeral fractures was performed in 30 patients, 23 women and 7 men, with an average age of 58.5 years. According to the Neer classification there were 10 two-part, 9 three-part and 11 four-part fractures. Internal fixation was achieved with Kirschner wire (n = 9), cancellous screws (n = 4) or tension band (n = 17). The technique of internal fixation with Kirschner wire and lateral tension band is described. Follow-up examination was possible in 26 patients after 14 months. The functional results were excellent in 6 cases, good in 4, satisfactory in 14, and poor in 2 cases. According to Neer's protocol the overall results were excellent in 5 cases, satisfactory in 7 cases, unsatisfactory in 7 cases and poor in 7 cases. The treatment of displaced proximal humeral fractures, especially in elderly patients, is still an unsolved problem. As functional results were satisfactory or even better in three-quarters of the four-part fractures treated, we conclude that internal fixation using Kirschner wire and tension band can be recommended.     

Open reduction internal fixation of lateral humeral condyle fractures in children. A series of 105 fractures from a single institution

Lateral humeral condyle fractures account for 17 % of the distal humeral condyle fractures. Displaced and/or rotated fractures require appropriate reduction and stabilisation. There are, however, a number of controversies in the surgical management of these patients. The aim of the present study was to review the results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation (ORIF). We retrospectively reviewed children treated with ORIF of lateral humeral condyle fractures at a single institution over a period of 13 years. All cases were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and final outcomes at the latest follow-up were reviewed. One hundred and five lateral condyle fractures were identified in 76 male and 29 female patients. Average age was 6.2 years. Ninety-two were Milch type II and 13 Milch type I. According to the Jacob’s classification, 38 were type II and 67 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to radiological union was 33 days. Follow-up ranged between 2 and 8 years (average 3.2 years). Radiological hypertrophy of the lateral condyle was present in 45 cases (42 %). Three patients developed a pseudo-cubitus varus deformity. Further four patients developed a true cubitus varus. There was one case of superficial infection of the K-wires and one case of delayed union. At the latest follow-up, 96 % of the patients achieved an excellent final result and 4 % a good final result. Our results demonstrate that fracture union and excellent final outcomes can be expected in all patients using our protocol, whereby all patients with a displaced fracture are managed by ORIF with K-wire fixation, with the wires only being removed after there is evidence of radiological union. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique. Level of evidence Case series, Level IV.     

Pyrford钢丝环扎张力带内固定治疗髌骨骨折的生物力学分析及临床研究

[目的] 测试Pvrford钢丝环扎加张力带内固定治疗髌骨骨折的生物力学特性，为临床治疗提供理论依据。[方法] 采集新鲜牛尸体膝关节标本，制成髌骨骨折模型，用Pyrford钢丝环扎加张力带固定，并与克氏针张力带、单纯钢丝环扎进行对照比较。[结果]Pyrford钢丝环扎加张力带内固定其强度和刚度相当于传统的8字形克氏针张力带，而且髌骨的应变、位移很小。临床应用Pyrford钢丝环扎加张力带内固定治疗髌骨骨折105例，随访6～23个月，优良率达98％。[结论]Pyrford钢丝环扎加张力带固定完全符合髌骨的生物力学性能，且能达到解剖复位，操作简便，固定牢固，适应早期功能锻炼的目的。     

三种不同内固定方法治疗髌骨骨折疗效分析

目的：比较三种髌骨骨折内固定的疗效。方法：手术治疗髌骨骨折98例，其中20例采用粗丝线环形缝合固定，36例采用克氏针张力带固定，42例采用镍钛聚髌器（NT－PC）固定。结果：粗丝线环形缝合固定组：优7例，良11例，中2例；克氏针张力带固定组：优18例，良16例，中2例，镍钛聚髌器固定组；优39例，良3例。结论：三种不同内固定方法比较结果表明镍钛聚髌器固定效果最好，其优良率达100％。