肱骨髁上骨折合并肱动脉损伤

目的：探讨儿童肱骨髁上骨折合并肱动脉损伤的受伤机制,诊断及手术治疗。方法：总结本院１９８９年７月－１９９８年１０月共收治９例肱骨髁上骨折合并不同类型的肱动脉损伤采取手术治疗方法。结果：９例术后４－６围内骨折愈合,８例前臂血运得以良好的恢复,仅１例因伤后时间长术后仍发生前臂缺血性挛缩。     

儿童肱骨髁上骨折合并肱动脉损伤

目的 探讨儿童肱骨髁上骨折合并肱动脉损伤的受伤机制、诊断及手术治疗。方法 收治９例肱骨髁上骨折合并不同类型的肱动脉损伤病人,肱动脉完全性断裂４例;肱动脉被肱骨近端前下缘尖利之骨端刺破１例;肱动脉节段性血栓栓塞１例;肱动脉痉挛３例。所有病人在解除血管压迫,探明血管损伤情况后进行骨折牵引复位。结果 术后４～６周内骨折愈合,８例前臂血运得以良好的恢复,仅１例因伤后时间长,术后仍发生晚期前臂缺血性挛缩。结     

合并肱动脉损伤的儿童肱骨髁上骨折的手术治疗

目的探讨合并肱动脉损伤的儿童肱骨髁上骨折的手术治疗疗效。方法 2006年2月至2010年12月手术治疗合并肱动脉损伤的儿童肱骨髁上骨折8例,术前检查患侧桡动脉搏动消失的6例患儿行急诊探查、内固定术;桡动脉搏动减弱的2例患儿先行保守治疗。观察12h后桡动脉搏动无明显恢复,患儿前臂进行性肿痛加重,则行急诊切开探查、内固定治疗。术中可见骨折近端压迫肱动静脉致血管痉挛6例,肱动脉血栓形成1例,肱动脉部分破裂1例。6例血管痉挛者在骨折复位后血管搏动恢复正常。肱动脉血栓形成者给予切开取栓,动脉部分破裂者给予直接缝合。术毕两者肱动脉搏动均恢复正常。术后肘关节屈曲90°石膏固定。结果 8例患儿全部得到随访,随访时间5个月～2年,平均16个月。所有患儿桡动脉搏动均正常。骨折均在术后4～6个月愈合,拔除克氏针。无伤口感染、肘内翻畸形等发生。结论对于合并肱动脉损伤的儿童肱骨髁上骨折,术前桡动脉搏动是一个重要的判断指征。一旦怀疑肱动脉损伤,应尽早手术。     

儿童肱骨髁上骨折合并肱动脉损伤的治疗

目的探讨儿童肱骨髁上骨折合并肱动脉损伤的诊治经验。方法回顾性研究2010年1月至2014年1月收治的10例GartlandⅢ型肱骨髁上骨折合并肱动脉损伤的病例资料。其中8例闭合性骨折均采用前臂外侧切开复位,经皮克氏针内固定。2例开放性骨折清创后,从骨折穿破皮肤处入路,复位后经皮克氏针固定。骨折复位固定后显露肱动脉损伤部位。6例肱动脉痉挛患儿首先解除机械性痉挛,再行局部热敷,药物罂粟碱外膜注射。4例肱动脉断裂者先取出血栓,2例动脉缺损在2 cm以内行断端吻合,2例血管损伤重,修整后动脉缺损5~7 cm,行自体大隐静脉移植,术后抗凝治疗1周。结果术后随访10~18个月,平均15个月。术后4~6周复查,10例肱骨髁上骨折伴肱动脉损伤的患儿均骨折愈合,肢端及前臂血循环恢复良好,无一例发生前臂缺血性肌挛缩。最后一次复查时,10例肘关节活动均良好,伸屈活动范围正常,桡动脉搏动正常,复查血管彩超吻合段血管无狭窄、无假性动脉瘤。结论肱动脉损伤是儿童肱骨髁上骨折最严重的并发症,对可疑有血管损伤者,应仔细连续动态观察,一旦确诊,手术应尽早进行,必要时请血管外科医生辅助手术,早期手术疗效较好。     

小儿肱骨髁上骨折伴迟发性肱动脉血栓形成1例

<正>肱骨髁上骨折约占儿童骨折的12%,约3%～12%合并血管损伤,特别是肱动脉损伤。急性肱动脉血栓形成已屡见不鲜~([1]),但迟发性动脉血栓形成鲜有报道,本院诊治1例肱骨髁上骨折患儿,采用闭合复位克氏针固定术治疗~([2]),术后7 d出现肱动脉血栓形成,报道如下。     

儿童肱骨髁上骨折并肱动脉正中神经损伤的治疗

肱骨髁上骨折是最常见的儿童肘部骨折,约占全部肘关节损伤的60%而合并肱动脉损伤一般在10%以下[1].自1994年1月～2007年7月,笔者收治12例儿童肱骨髁上骨折合并肱动脉正中神经损伤,经过及时处理获得较好效果,报告如下.     

肱骨髁上骨折并肱动脉损伤16例分析

肱骨髁上骨折并肱动脉损伤１６例分析刘祥青李伟丛杰高斯徐茂东我院１９８９～１９９５年共收治小儿肱骨髁上骨折并肱动脉损伤１６例，占同期肱骨髁上骨折的９．６％，分析讨论如下：临床资料：男１１例，女５例，左侧５例，右侧９例，皆为新鲜闭合骨折，年龄４～１０岁...     

肱三头肌两侧开窗入路手术治疗儿童肱骨髁上骨折

目的介绍一种治疗儿童肱骨髁上骨折的新手术入路,即肱三头肌两侧开窗入路。方法对儿童肱骨髁上骨折16例采用肘后正中切口,从肱三头肌的两侧作2个开窗入路显露骨折端,行骨折复位交叉克氏针内固定。结果此入路术中显露骨折端充分。方便骨折复位内固定,术后随访3个月以年,所有骨折均愈合,肘关节功能恢复理想。结论采用肱三头肌两侧开窗入路手术治疗儿童肱骨髁上骨折,对肱三头肌伸肌装置损伤小,显露骨折端容易,可有效防止桡神经损伤和肘肌失神经支配,肘关节功能恢复佳,是儿童肱骨髁上骨折的理想入路选择。     

儿童肘部损伤664例分析

为了了解儿童肘部损伤分类情况 ,作者把经本人治疗的 ,有较完整记载的 6 6 4例 16岁及以下儿童肘部损伤病例作初步分析如下。1　临床资料本组 6 6 4例中 ,男 44 9例 ,女 2 15例 ;年龄 5个月～ 16岁 ;左侧损伤 315例 ,右侧损伤 34 9例 ;肱骨下端损伤 44 9例 ,前臂上段损伤 110例 ,肱骨下端合并前臂损伤 15例 ,肘关节扭伤 90例。损伤分类情况 ,见表 1。损伤年龄分布情况 ,见表2。表 1　损伤分类损伤类别例数肱骨髁上骨折肱骨下端骨骺损伤 (骨折 )肱骨外髁翻转骨折肱骨内上髁骨骺损伤 (骨折 )肱骨外髁并内上髁骨骺损伤肱骨外髁骨骺损伤后合并髁…     

骨片钉治疗儿童肱骨髁上骨折

目的 回顾分析骨片钉内固定治疗儿童髁上骨折的手术方法及治疗效果.方法 采用骨片钉治疗Gartland Ⅱb型、Ⅲ型儿童髁上骨折32例.采用前侧入路,复位后交叉骨片钉固定.对开放性骨折及肱动脉受压行急诊清创、切开复位内固定手术.结果 术后获3～18个月随访,平均7.6个月,所有骨折均一期骨愈合.根据Flynn标准评定疗效:优29例,良3例.结论 骨片钉是儿童肱骨髁上骨折的一种较为可靠的固定方法,对于开放性骨折或伴有血管神经损伤的骨折行前侧人路损伤小,暴露充分,操作方便.     

带锁髓内钉治疗新鲜四肢长骨干骨折1224例疗效分析

目的总结带锁髓内钉治疗肱骨干、股骨干、股骨髁上、胫骨干和转子间骨折的疗效。方法自1996年10月至2004年6月间使用带锁髓内钉治疗的有完整资料的新鲜四肢骨折1224例,男778例,女446例;平均年龄39岁(16￣92岁)。骨折位于肱骨干92例,股骨转子间210例,股骨干488例,股骨髁上92例,胫骨342例。闭合骨折按AO分型:A型642例;B型364例;C型218例。开放骨折15例(GustiloⅠ型8例,GustiloⅡ型7例)。受伤至手术时间平均为8d(3h￣33d)。闭合复位1203例,切开复位23例;扩髓409例,非扩髓815例。结果平均随访时间为24个月(6￣70个月)。1204例骨折愈合,愈合率为98.2%,平均愈合时间为5个月(3￣12个月)。骨折不愈合22例,其中肱骨4例,股骨8例,股骨髁上4例,胫骨6例,总不愈合率为1.8%。术后无急性感染发生,3例发生晚期深部感染,总感染率为0.2%。术中16例发生严重骨折劈裂,4例为肱骨逆行髓内钉固定,4例Gamma钉固定,9例为股骨逆行髓内钉固定,占1.3%。6例发生医原性神经损伤,占0.4%。股骨髓内钉主钉断裂1例,锁钉断裂9例(0.6%)。晚期髓内钉末端骨折3例,占0.2%。53例主诉髓内钉尾端部位不适,占4.3%。结论闭合复位带锁髓内钉治疗骨干骨折在骨折愈合率、感染率、出血量、功能恢复情况和早期活动方面均较满意,是治疗骨干骨折较好的方法,但     

The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children

BACKGROUND: The purpose of this study was to evaluate the perioperative complication rates associated with early surgical treatment (eight hours or less following injury) and delayed surgical treatment (more than eight hours following injury) of displaced supracondylar humeral fractures in children. METHODS: Fifty-two patients had early surgical treatment and 146 patients had delayed surgical treatment of a displaced supracondylar humeral fracture. The perioperative complication rates of the two groups were compared with the use of bivariate and multivariate statistical methods. RESULTS: There was no significant difference between the two groups with respect to the need for conversion to formal open reduction and internal fixation (p = 0.56), pin-track infection (p = 0.12), or iatrogenic nerve injury (p = 0.72). No compartment syndromes occurred in either group. Power analysis revealed that our study had an 86% power to detect a 20% difference between the two groups if one existed. CONCLUSIONS: We were unable to identify any significant difference, with regard to perioperative complication rates, between early and delayed treatment of displaced supracondylar humeral fractures. Within the parameters outlined in our study, we think that the timing of surgical intervention can be either early or delayed as deemed appropriate by the surgeon.     

Epidemiologic pattern of paediatric supracondylar fractures of humerus in a teaching hospital of rural India: A prospective study of 263 cases

Purpose: This prospective study aimed to investigate the epidemiologic parameters of supracondylar humeral fractures in children admitted to a teaching institution of a developing country primarily catering to rural population, to find any preventable cause of such injuries. Methods: All suspected cases of supracondylar humeral fracture reporting to emergency or outpatients department were analysed for various epidemiologic parameters including age, sex, laterality, time of presentation, associated injuries, neurovascular complications and classification over a period of four years. Results: We analysed a total of 263 patients and most of the fractures were seen in 5e8-year age group with a mean of 7.9 years. A total of 157 cases were males and non-dominant extremity was involved in 65% of fractures in our series. Fall on outstretched hand was the predominant cause of injury and fall from rooftop was the predominant mode. In all patients, 36.12% reported to our hospital 1 week after injury, 39.92% presented to hospital within 48 h after trauma and the remaining 23.95% presented 48 h to 1 week after trauma. None had a bilateral injury. Gartland type 3 fractures constituted 54.37% of patients, followed by type 1 (23.95%) and type 2 (21.67%). Conclusion: Almost one fourth of supracondylar humeral fractures in children can be prevented by installing railing of rooftops and stairs. It is necessary to educate people on hazards of treatment by traditional bonesetters. Moreover, the children with supracondylar humeral fractures should be screened for associated injuries.     

Comparison of complications and results of early versus delayed surgery for Gartland type III supracondylar humeral fractures in pediatric patients

Objective: To investigate the effect of timing of surgery on clinical results and perioperative complications in pediatric patients with Gartland III type supracondylar humeral fractures without neurovascular compromise. Methods: Eighty‐six c onsecutive children treated surgically at our hospital from April 2005 to June 2007 for displaced supracondylar humeral fractures were reviewed. All these patients were treated by the same group of doctors. The children were divided into two groups: early if treated within 12 hours after injury and delayed if treated later than that. Perioperative complications and clinical results, especially for open surgery, were compared between the two groups. Results: Forty pediatric patients underwent surgery in the early group and 46 in the delayed group. There were no significant differences between the two groups in perioperative complications such as pin tract infection, iatrogenic nerve injury, compartment syndrome and conversion to open surgery. For open surgery, both the clinical results and perioperative complications were not affected by delaying for more than 12 hours after injury. However, blood loss and operation time were greater in the early than in the delayed group, possibly due to relatively more edema. Conclusion: Delay in surgery, regardless of whether it is closed or open, for more than 12 hours after injury does not influence the perioperative complications and clinical results for displaced supracondylar humeral fractures in children. However early open reduction and pinning may increase intra‐operative blood loss and take longer.     

克氏针固定治疗儿童肱骨髁上骨折不同进针方式的比较

目的 通过克氏针固定治疗儿童肱骨髁上骨折两种进针方式的疗效比较,探讨儿童肱骨髁上骨折内固定方式的选择.方法 在2004年1月至2009年1月收治的肱骨髁上骨折患儿中,选择骨折类型相似,而克氏针进针方式不同(内外交叉固定及外侧平行克氏针固定)两组共64例患儿.按照Gartland分型,内、外交叉克氏针固定组(交叉固定组)38例,其中Ⅱ型21例,Ⅲ型17例;外侧平行克氏针固定组(外侧进针组)26例,Ⅱ型18例,Ⅲ型8例.并对两组术后功能优良率进行统计学比较.结果 64例患儿术后获得6～54个月(平均26个月)的随访.两组关节功能优良率分别为92.1%和84.6%,差异无统计学意义(P＞0.05).但交叉固定组术后出现4例尺神经损伤,外侧进针组则无此情况发生.结论 采用克氏针内固定治疗儿童肱骨髁上骨折,内外交叉和外侧平行进针固定效果相似,但外侧进针操作更简单,且可避免医源性尺神经损伤,是治疗GartlandⅡ、Ⅲ型肱骨髁上骨折的一种有效方式.

Abstract：

Objective To compare the treatment outcomes of techniques of K-wire fixation for treatment of supracondylar humeral fractures in children and provide guidelines for selection of internal fixation methods for humeral supracondylar fractures in children.Methods Sixty-four cases d humeral supracondlylar fractures in children were treated by K-wire internal fixation from January 2004 to January 2009.They were divided into 2 groups, with similar fracure types distributed to each group.Group one (crisscross K-wire fixation) contained 38 cases among which 21 were Gartlad Ⅱ fractures and 17 were Gartland Ⅲ fractures.Group two (lateral parallel K-wire fixation) cases contained 26 cases among which 18 cases were Gartland Ⅱ fractures and 8 cases were Garland Ⅲ fractures.Postoperative elbow functions were evaluated and compared between the two groups.Statistical analysis of the excellent-good rate was carried out.Results Postoperatively all 64 patients were follow-up for 6 to 54 moths (average 26 months).The excellent-good rate of elbow fiuctions in group one and two was 92.1% and 84.6%, respectively.There was no significant difference in functional recovery between the two fixation methods (P＞ 0.05).However ulnar nerve injury occurred in 4 cases of the crisscross K-wire insertion group, while none occurred in the lateral parallel K-wire insertion group.Conclusion Crisscross and lateral parallel K-wire fixation have similar clinical outcomes in treating humeral supracondylar fiactures in children.Lateral parallel K-wire fixation technique is simpler and can avoid the risk of iatrogenic ulnar nerve injury.It therefore is an effective method to treat Gartland Ⅱ and Ⅲ supracondylar humerus fractures.     

早期与延迟手术治疗儿童Gartland Ⅲ型肱骨髁上骨折的疗效比较

目的 比较早期与延迟手术治疗儿童Gartland Ⅲ型肱骨髁七骨折的疗效.方法 对2001年1月至2007年6月收治的86例闭合性、无血管神经损伤的GartlandⅢ肱骨髁上骨折患儿资料进行回顾性分析,根据受伤至手术时间分为早期手术组(<8 h)和延迟手术组(>8 h),其中34例早期手术(伤后平均7.2 h手术),52例延迟手术(伤后平均49.5 h手术).对两组患儿开放复位率、手术时间、医源性神经损伤发生率、针道与切口感染率、骨折愈合时间及肘关节功能恢复情况进行比较.结果 早期手术组和延期手术组在开放复位率、手术时间、医源性尺神经损伤发生率、针道与切口感染率、骨折愈合时间及肘关节功能恢复情况等方面差异均尢统计学意义(P>0.05).结论 早期手术和延期手术对儿童Gartland Ⅲ型肱骨髁上骨折的疗效尤明显影响,因此临床上应尽量在术前准备充分、患肘肿胀相对消退时进行手术.     

肱骨髁上骨折的治疗方法及疗效分析

目的 探讨肱骨髁上骨折的治疗方法和疗效。方法手术治疗肱骨髁上骨折43例。肱骨远端Y型钢板固定6例,双张力带固定17例,单张力带固定20例。结果所有患者均获得随访,时间6—28（18．2±3．4）个月,肘关节功能按Morrey评定标准进行评定：优34例,良7例,差2例。结论肱骨髁上骨折应采用Y型板双张力带进行双柱固定,而双克氏针张力带内固定手术操作简单,时间短,出血少,固定可靠,如掌握恰当的适应证,其疗效与Y型板固定相近。     

Internal Fixation of Proximal Humeral Fractures: Current Concepts

Abstract Fractures of the proximal humerus are an increasingly common type of injury. Mainly elderly patients with osteoporotic bone are affected. Whereas non-displaced and stable fractures are managed successfully with conservative treatment, there is no general agreement on the surgical strategy for displaced and unstable two- to four-part fractures. The clinical outcome is influenced by the fracture type and concomitant injury to the rotator cuff. Extensive surgical manipulation of the soft tissues, non-anatomic and/or unstable fixation as well as technical errors are important contributing factors to poor clinical results.Goals of surgical treatment are to restore anatomy, to achieve fixation that is stable enough to allow early mobilization, to avoid secondary displacement and not to harm the blood supply of the humeral head in order to minimize the risk for avascular necrosis.Minimally invasive procedures using closed reduction are advantageous for protection of the arterial blood supply. Plate fixation offers superior biomechanical stability. There is a recent tendency to use fixedangle implants for proximal humeral fractures in order to avoid secondary loss of fixation. Locked plates acting as internal fixator as well as intramedullary nails better adapt according to the biomechanical and anatomical characteristics of the proximal humerus. First clinical experience with those implants is encouraging but they do not compensate for an insufficient surgical technique.     

Surgical management for late presentation of supracondylar humeral fracture in children

PURPOSE: To report the results of surgical management for late-presenting displaced supracondylar fractures of the humerus in children. METHODS: Between February 2002 and June 2003, 40 children (mean age, 7 years) with late presentation (range, 2-12 days) of displaced supracondylar humeral fractures were prospectively recruited. Gentle closed manipulation under image intensification was attempted in all patients, except one with a compound open fracture. Manipulation was successful in 25 patients and percutaneous skeletal stabilisation with Kirschner wires was performed. The remaining 15 patients were treated with open reduction and Kirschner wire fixation, using a mediolateral approach. RESULTS: The mean delay in presentation was approximately 4 days. No patients presenting more than 7 days after injury had the fracture reduced by closed manipulation. The mean hospital stay was 41 hours. At the final follow-up (mean, 18 months), 88% of the patients had a satisfactory result, according to Flynn's criteria. CONCLUSION: Operative treatment for late presentation of supracondylar humeral fractures in children is effective. It minimises the risk of complications and the need for continuous traction or corrective osteotomy.     

外侧微型钢板及克氏针辅助固定治疗儿童肱骨远端骨干-干骺端交界性骨折

目的:探讨外侧微型钢板及克氏针辅助固定治疗儿童肱骨远端骨干-干骺端交界性骨折的手术方法及临床疗效。方法:回顾性分析自2015年1月至2018年12月收治的21例肱骨远端骨干-干骺端交界性骨折患儿,男12例,女9例;年龄2～10岁,平均4.5岁;受伤至手术时间6 h～7 d。影像学资料显示骨折线位于肱骨远端骨干-干骺端交界区域,斜形骨折10例,横形骨折8例,粉碎骨折3例。手术方式均采用切开复位外侧微型钢板及克氏针辅助内固定,采用改良Flynn肘关节评分标准进行临床疗效评价。结果:21例患儿均得到随访,时间8～24个月,平均13个月,愈合时间为6～8周,平均7.2周,术后均未出现骨折再移位、肘内翻畸形及尺神经损伤等并发症。按照改良Flynn肘关节评分标准进行评价,优19例,良2例。结论:儿童肱骨远端骨干-干骺端交界性骨折与肱骨髁上骨折治疗方法不同,采用切开复位外侧微型钢板及克氏针辅助固定治疗具有稳定性强、功能良好、并发症少的优点值得临床推广。