伴“无脉手”的儿童肱骨髁上骨折的治疗

目的　总结不能触及桡动脉的儿童肱骨髁上骨折的治疗方法与效果。 方法　回顾2010年1月至2018年6月住院治疗并随访1年以上的肱骨髁上骨折伴“无脉手”的病例45例。其中男孩23例，平均年龄5岁8个月；女孩22例，平均年龄5岁6个月；摔伤37例，乘坐电动车摔伤4例，高空坠落伤3例，交通伤1例。均为Gartland Ⅲ型骨折。予以闭合复位克氏针固定术18例，切开探查血管及骨折复位克氏针固定术27例。多普勒评价动脉搏动及有无血流灌注。术后4周去除石膏及克氏针。 结果 患儿随访12至15个月，平均随访13个月。骨折均在4 ~ 12周骨性愈合。采用Flynn等临床功能评定标准，肘关节功能优42例，良3例。末次随访时桡动脉搏动良好，未出现再移位、针道感染及肘内翻等并发症。 结论 “苍白手”应立刻探查血管，“粉红手”闭合复位克氏针固定术后48 h内应密切观察桡动脉搏动，闭合复位术失败者或术后多普勒检查与术前有异者应切开探查血管、复位骨折并固定。移位大的肱骨髁上骨折闭合复位术后应注意观察桡动脉搏动。

Treatment of supracondylar fracture of humerus with pulseless hands in children

Objective　To summary the therapeutic method and clinical effect of supracondylar fractures of the humerus with pulseless hand in children.　Methods　A total of 45 patients of humeral supracondylar fracture with pulseless hands were hospitalized and followed up for more than one year from January 2010 to June 2018. There were 23 boys, with an average age of 5 years and 8 months. There were 22 girls, with an average age of 5 years and 6 months. There were 36 cases of fall injury, 4 cases of electric vehicle falls, 3 cases of high fall, and 1 case of traffic accident. All cases were Gartland type III fractures. Closed reduction and Kirschner wire fixation were performed in 18 cases, and open exploration of blood vessels and fracture reduction with Kirschner wire fixation in 27 cases. Arterial pulse and the presence or absence of perfusion were evaluated by Doppler. Plaster and Kirschner wire were removed 4 weeks after surgery.　Results　The children were followed up for 12 to 15 months, with an average follow-up of 13 months. The fractures all healed around 4-12 weeks. According to Flynn evaluation standard of elbow performance score: excellent in 42 cases and good in 3 cases. At the last follow-up, the radial artery pulsation was good, and there were no complications such as redisplacement, pin tract infections and cubitus varus. Conclusions　The pale hand should be explored the vessels immediately, and the failed closed reduction. Radial arterial pulsation should be closely observed within 48 h after closed reduction and Kirschner wire fixation for pink hand. Blood vessels should be opened for exploration, fracture reduction and fixation for those who failed closed reduction or had differences between preoperative and postoperative Doppler examination. After reduction of the supracondylar fracture of the humerus, attention should be paid to the presence or absence of radial artery pulsation.