肘后外侧小切口及有序骨折复位固定治疗儿童肱骨髁上骨折

【目的】探讨经肘后外侧小切口有序骨折复位治疗儿童肱骨髁上骨折的临床疗效。【方法】1999～2007年，对76例手法复位失败、无合并神经、血管损伤的儿童肱骨髁上骨折采用肘后外侧小切口手术，术中采取有序的骨折复位方法，先复位固定肱骨远端外侧柱，后复位固定肱骨远端内侧柱。术后患肢石膏托外固定2～3周并进行功能锻炼。【结果】全部病例均获随访，平均随访时间4年（1～6年）。按Flynn标准对术后肘关节功能恢复情况进行评价，其中优61例，良15例，优良率为100％，无肘内翻发生。【结论】肘后外侧小切口及有序骨折复位固定适用于闭合复位不满意但不伴有明显神经、血管损伤的儿童肱骨髁上骨折，本术式具有解剖关系简单，对组织损伤小，出血少等优点；便于骨折复位、固定，能有效防止骨折远端内移、内旋、内倾及预防肘内翻畸形发生。

Ordered Reduction for Puerile Humeral Supracondylar Fracture Through Small Incision in Outer Margin of Elbow

Objective]To evaluate the clinical effect of the ordered reduction for puerile humeral supracondylar fracture through small incision in outer margin of elbow. Methods] The ordered open reduction and internal fixation was performed on 76 children with obvious displacement of humeral supracondylar fracture without injury of blood vessel or nerves. The lateral condylar post of humerus was reduced and fixed at first, then the medial condylar post. The elbow was protected by plaster slab for 2-3 weeks and functional exercise was performed. Results] All of them were followed up （average 4 years, from 1-6 years）. The function of the elbow was evaluated by Flynffs index. The results showed that 61 cases were excellent and 15 cases were good. No postoperative complications as cubitus varus happened. Conclusion]The ordered open reduction and internal fixation is an effective approach for puerile humeral supracondylar fracture without injury of blood vessel or nerves. It has advantages of simper anatomy, minimally inva- sive and less bleeding, and is easy to reduction and fixation of fractures. It also can prevent the ingression, internal rotation and introversion of distal end of humerus, and reduce the incidence rate of cubitus varus.