小切口张力带内固定治疗儿童肱骨髁上骨折

目的探讨采用肱三头肌两侧小切口入路交叉克氏针加桡侧钢丝张力带治疗儿童完全移位肱骨髁上骨折的临床疗效。方法收集2005年6月~2015年11月收治的儿童完全移位肱骨髁上骨折61例,男性47例,女性14例;年龄3~13岁,平均8.5岁。摔伤55例,道路交通伤6例。其中闭合性骨折59例,开放性骨折2例;右侧50例,左侧11例;伸直型57例,屈曲型4例。应用肱三头肌两侧小切口入路,桡侧克氏针张力带内固定治疗,术中置管引流,术后无需外固定,早期功能锻炼。结果本组均在门诊摄X线片随访,随访时间3~36个月,平均20个月。X线片显示61例均解剖复位,骨折平均愈合时间为8周,无肘内翻畸形发生。根据Flynn评定标准,优42例,良16例,可2例,差1例,优良率达95%。结论肱三头肌两侧小切口入路交叉克氏针加桡侧钢丝张力带治疗儿童完全移位肱骨髁上骨折,具有操作简单、固定可靠、肘关节功能恢复满意等优点,是治疗儿童肱骨髁上骨折的一种有效方法。

Minimal incision and lateral tension band for supracondylar fracture of the humerus in children

Objective To study the effect of complete dislocated supracondylar fracture of the humerus in children with lateral tension band with internal steel wire fixation through bilateral triceps approach.Methods Totally 61 children with completely dislocated humeral supracondylar fracture were treated by lateral tension band with internal steel wire fixation through bilateral triceps approaches.Among them 47 were male and 14 were female with an average age of 8.5(3-13) years.Fifty-five cases were injured from falling and 6 were from road traffic accidents.Fifty-six cases were closed injury and 2 were open injury.Fifty cases were on the right and 11 on the left with 57 cases of extension type and 4 cases of flexion type.Tubes were inserted during operation for drainage the blood after operations.Early functional exercises were done without external fixation.Results All 61 cases were followed-up by X-ray for 3-36 months,20 months on average.Anatomy reduction was achieved in all patients.All fractures achieved bone union without cubitus varus,and the average union time was 8 weeks.According to Flynn function assessment system,the curative effect was excellent in 42 cases,good in 16,fair in 2 and poor in 1.The excellent and good rate was 95%.Conclusion Minimal incision and lateral tension band for complete dislocated supracondylar fracture of the humerus in children has many advantages such as simple implement,reliable fixation,satisfactory recovery of elbow joint function after operation.It is an ideal method for the treatment of the humeral supracondylar fractures.