石膏与夹板配合应用治疗儿童GartlandⅢ型肱骨髁上骨折

目的：探讨石膏与夹板结合外固定治疗儿童难复性肱骨髁上骨折（Gartland Ⅲ型）的方法及疗效。方法：对2002年3月至2006年5月治疗的24例Gartland Ⅲ型肱骨髁上骨折患儿进行回顾性分析,其中男14例,女10例;年龄4～12岁,平均6.6岁;左侧10例,右侧14例。对患儿先施行手法复位,以能维持肱骨长度,不强求解剖复位,石膏外固定5～7d,肿胀消退后根据复位情况进行再次手法复位矫正,改用夹板外固定4～5周直至骨折愈合。结果：24例均获随访,时间5个月～2年,平均1.2年。所有病例无神经血管损伤、骨化性肌炎、前臂骨筋膜室综合征与Volkmann挛缩等并发症。按照朱小庭儿童肱骨髁上骨折疗效评定标准进行评定,优12例,良8例,可3例,差1例。结论：应用石膏与夹板配合治疗儿童Gartland Ⅲ型肱骨髁上骨折,可以避免反复整复而加重骨折断端及周围软组织损伤,动态矫正骨折端,获得满意的复位,减少并发症的发生,并能在较短时间内恢复肘关节功能。     

闭合复位治疗儿童Gartland Ⅱ型和Ⅲ型肱骨髁上骨折

目的:探讨儿童GartlandⅡ型和Ⅲ型肱骨髁上骨折闭合复位及固定的治疗方法。方法:自2004年1月至2011年12月收治儿童肱骨髁上骨折110例,男76例,女34例;年龄2～13岁,平均7岁;伸直型98例,屈曲型12例;GartlandⅡ型32例,GartlandⅢ型78例;伴有远折端旋转移位37例。分别在血肿内、臂丛及氯胺酮麻醉下,握持患肢的上臂及前臂对抗牵引,牵引数分钟后行手法闭合复位,经C形臂X线透视示骨折复位满意后用石膏托固定,对不稳定性骨折复位后经皮桡侧穿入1～2枚克氏针内固定再加石膏外固定。术后3～4周摄X线片,拆除石膏并拔出克氏针,开始康复锻炼。结果:110例均获随访,时间3～18个月,平均12个月,所有患儿获得骨性愈合,骨折愈合时间6～8周,平均6.9周。无一例出现肘内翻畸形、血管神经损伤或Volkmann挛缩等并发症。按Flynn标准评定疗效:优74例,良26例,可10例。结论:采用闭合复位石膏托外固定并对不稳定性骨折经皮克氏针内固定加石膏托外固定治疗儿童GartlandⅡ型和Ⅲ型肱骨髁上骨折是一种操作简单、创伤小、疗效较好的方法。     

闭合复位经皮克氏针交叉固定治疗儿童GartlandⅡ型肱骨髁上骨折

目的探讨闭合复位经皮克氏针交叉固定治疗儿童GartlandⅡ型肱骨髁上骨折的临床疗效。方法回顾性分析我科自2015年7月至2018年5月收治的36例儿童肱骨髁上骨折的病例资料,按照Gartland分型均为Ⅱ型骨折,其中ⅡA型16例,ⅡB型20例,均为闭合性骨折;男19例,女17例;平均年龄5.8(3~12)岁。所有病例均行闭合复位经皮内外侧交叉克氏针固定,术后长臂管型石膏固定3周,拆除石膏后进行肘关节屈伸功能锻炼。术后采用Flynn肘关节评分标准评定临床疗效。结果手术时间平均32(20~45)min。本组36例患儿无一例出现医源性尺神经损伤、Volkmann挛缩或肘内翻畸形,其中1例出现针道轻度感染,拔出克氏针后口服头孢类抗生素后痊愈。平均随访13.2(12~24)个月,末次随访按照Flynn临床功能评定标准评定临床疗效:优29例,良6例,可1例,优良率97.2%。结论闭合复位经皮内外侧交叉克氏针固定是治疗GartlandⅡ型儿童肱骨髁上骨折的有效方法,早期复位固定可有效减少单纯石膏固定引起的骨折移位、肘内翻畸形等并发症的发生,有利于肘关节的功能恢复。     

闭合复位交叉螺纹针内固定治疗儿童GartlandⅢ型肱骨髁上骨折

目的探讨闭合复位交叉螺纹针内固定治疗儿童GartlandⅢ型肱骨髁上骨折的疗效。方法对32例儿童GartlandⅢ型肱骨髁上骨折行闭合复位交叉螺纹针内固定术。结果术后所有患者无神经、血管损伤。平均随访15个月,肘内翻1例,根据Mayo肘关节功能评定:优30例,良2例。结论闭合复位交叉螺纹针固定术后不需要石膏外固定,手术创伤小,并发症少,是目前治疗GartlandⅢ型肱骨髁上骨折较为理想的手术方法。     

闭合复位经皮克氏针固定与单纯石膏固定治疗儿童Gartland ⅡB型和Ⅲ型肱骨髁上骨折疗效比较

目的 比较闭合复位经皮克氏针固定与单纯石膏固定治疗儿童Gartland ⅡB型和Ⅲ型肱骨髁上骨折的临床疗效。方法 回顾性分析自2020-03—2021-06诊治的78例儿童Gartland ⅡB型和Ⅲ型伸直型肱骨髁上骨折,其中38例骨折闭合复位后采用经皮克氏针固定（A组）,40例骨折闭合复位后采用单纯石膏外固定（B组）。比较两组骨折复位固定时间、X线透视次数、治疗后3个月肘关节功能Flynn评分,以及骨折闭合复位即刻、治疗后3个月Baumann角。结果 78例获得随访,随访时间平均5.5(3～12)个月。B组骨折复位固定时间较A组短,X线透视次数较A组少,差异有统计学意义（P<0.05）。A组1例出现针道感染,换药后痊愈。B组3例出现肘内翻畸形,二期行截骨矫形手术治疗。B组治疗后3个月Baumann角较骨折闭合复位即刻明显增大,差异有统计学意义（P<0.05）。A组治疗后3个月Baumann角小于B组,肘关节功能Flynn评分优于B组,差异有统计学意义（P<0.05）。结论 与闭合复位单纯石膏外固定比较,闭合复位经皮克氏针内固定治疗儿童Gartland ⅡB型和Ⅲ型肱...     

闭合复位克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折

目的探讨闭合复位内外侧3针交叉固定治疗GartlandⅢ型儿童肱骨髁上骨折的疗效。方法对195例GartlandⅢ型儿童肱骨髁上骨折患者行闭合复位后,C臂机监视下先在肱骨髁外侧用2枚克氏针平行或交叉固定,再伸直肘关节到50°,保护尺神经下用1枚克氏针在内侧交叉固定,术后长臂石膏托固定于肘关节伸直70°制动3周。结果 195例均获随访,时间5~35个月。出现医源性尺神经损伤2例,肘内翻畸形需截骨矫形1例,肘部前侧局限性骨化4例。按Flynn标准评定疗效:优180例,良8例,一般6例,差1例,优良率为96.4%。结论闭合复位内外侧3针交叉固定治疗GartlandⅢ型儿童肱骨髁上骨折可有效减少医源性尺神经损伤,降低肘内翻畸形发生率,疗效满意。     

内外侧小切口治疗儿童肱骨髁上GartlandⅢ型骨折

目的探讨经内外侧联合小切口入路治疗儿童肱骨髁上GartlandⅢ型骨折的疗效。方法手术治疗GartlandⅢ型儿童肱骨髁上骨折47例,采用内外侧联合小切口入路显露内髁及外髁,复位后交叉克氏针固定。结果 47例均得到随访,时间6个月～2年,骨折均愈合。参照Flynn标准评定肘关节功能:优39例,良5例,可3例,优良率为93.6%。结论经内外侧联合小切口入路治疗儿童肱骨髁上GartlandⅢ型骨折创伤小、出血少、术后并发症少,疗效满意。     

闭合复位桡侧3枚克氏针固定治疗幼儿GartlandⅡ型及Ⅲ型肱骨髁上骨折

目的:探讨幼儿期肱骨髁上骨折的特点及闭合复位桡侧穿针固定治疗的效果.方法:自2010年6月至2013年6月就诊幼儿GartlandⅡ型及Ⅲ型肱骨髁上骨折35例,其中男28例,女7例;年龄1岁1个月～2岁6个月,平均2岁1个月.按Gartland分型,Ⅱ型19例,Ⅲ型16例.均为闭合性骨折,其中合并桡神经损伤3例,合并骨间前神经损伤5例,无合并血管损伤.所有患儿采用闭合复位穿针桡侧3枚克氏针固定,后行屈肘90°位石膏外固定,术后第2天复查X线片,术后2～3周后拆除石膏行肘关节屈伸功能锻炼,术后4～5周根据骨折愈合情况拆除克氏针.观察手术时间,神经恢复情况及肘关节功能.结果:患儿均获得随访,骨折均骨性愈合,末次随访采用Flynn肘关节功能评定标准评定疗效,优28例,良4例,一般1例,差2例.结论:幼儿肱骨髁上骨折采用闭合复位桡侧3枚克氏针固定,具有微创、住院时间短、克氏针取出方便及治疗效果可靠的优点.     

儿童闭合性Gartland Ⅲ型肱骨髁上骨折合并血管神经损伤的治疗

目的 探讨治疗儿童闭合性GartlandⅢ型肱骨髁上骨折合并血管神经损伤的手术方法及疗效.方法 回顾性分析2000年7月至2003年6月治疗的398例儿童闭合性GartlandⅢ型肱骨髁上骨折患者资料,男207例,女191例;年龄1.3～14.0岁,平均7.5岁;伸直尺偏型372例,伸直桡偏型10例,屈曲型16例.桡动脉搏动缺失25例,较对侧减弱40例;正中神经损伤27例,桡神经损伤18例,正中神经和桡神经同时受累12例.所有患者均在伤后24 h内在臂丛神经阻滞麻醉和C型臂X线机监测下闭合复位满意后,分别在内、外髁部位穿入克氏针交叉固定,术后屈肘60°～ 90°位石膏托固定2周,主动功能锻炼,3周去除内固定,开始主动和被动功能锻炼.按照Flynn临床功能评定标准评定肘关节功能.结果 360例患者术后达解剖复位,38例复位后有轻度桡偏,肱骨前倾角略减小.桡动脉搏动恢复,术后3～24周(平均6周)神经损伤恢复.286例患者术后获6～ 27个月(平均18个月)随访,肘关节功能恢复正常,4例出现轻度肘内翻,但无需手术矫形.按照Flynn临床评定标准评定疗效:优280例,良6例,优良率为100％. 结论 充分麻醉下闭合复位、经皮穿针内固定可有效治疗儿童闭合性GartlandⅢ型肱骨髁上骨折合并血管神经损伤,可作为首选治疗方法之一.     

手法复位经皮克氏针固定治疗儿童肱骨髁上骨折的疗效观察

目的:探讨手法复位经皮克氏针固定治疗儿童肱骨髁上骨折临床疗效。方法:回顾性分析2010年7月至2012年12月采用手法复位经皮克氏针固定治疗52例儿童肱骨髁上骨折的临床资料, 其中男35例, 女17例;年龄2.5～12岁, 平均6.7岁;均为GartlandⅡ-Ⅲ型骨折, 其中51例伸直型, 1例屈曲型。采用肘关节功能Flynn评价标准进行临床疗效评价。结果:52例均得到随访, 时间12～18个月, 平均16个月。按照肘关节功能评价Flynn标准进行评价, 优41例, 良8例, 可3例。结论:手法复位经皮克氏针固定治疗儿童肱骨髁上骨折具有创伤小、恢复快、骨折固定稳定等优点, 还可预防骨筋膜室综合征及Volkmann挛缩、防止肘内翻。     

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.     

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。     

双切口克氏针及外侧可吸收张力带内固定治疗儿童肱骨髁上骨折

目的：探讨双侧克氏针结合外侧可吸收张力带内固定治疗儿童肱骨髁上骨折的临床疗效。方法：2006年至2010年采用双侧切口切开,交叉克氏针并可吸收张力带内固定治疗82例儿童肱骨髁上骨折,男53例,女29例;年龄5～12岁,平均7岁。根据骨折临床愈合后肘关节屈伸功能及肘部提携角结果,按Flynn评定标准综合评定疗效。结果：82例均获随访,时间0.5年,肘关节屈伸活动受限（2.8±3.7）°,提携角（12.7±2.2）°。依据疗效评定标准,优80例,良2例。结论：采用双侧切口交叉克氏针并可吸收张力带内固定治疗儿童肱骨髁上骨折,能早期进行肘关节功能锻炼,具有创伤小、固定牢固、恢复快的特点,是目前手术治疗儿童肱骨髁上骨折较理想的方法。     

Combination of ipsilateral supracondylar humeral- and forearm fractures in children

In an 11-year period, from 01. 08. 1987 to 31. 08. 1998, a total of 72 children (mean age 7.6 years, range 2-12 years) with dislocated supracondylar humeral fractures were treated surgically in the Department for Traumatology, University Hospital, Essen. The combination of supracondylar humeral fracture and ipsilateral forearm fracture occurred in 8 children (11.1 %). 4 revealed a complete forearm fracture in the distal third, 4 children a fracture of the distal physis (Salter-Harris type II). The supracondylar humeral fractures were reduced openly via a single lateral approach and stabilized by crossed K-wire fixation. The distal forearm fractures were treated by closed reduction and percutaneous pinning. Fractures of the distal physis were treated by closed reduction and application of an above elbow cast. Excellent results were achieved in all children with ipsilateral supracondylar and forearm fractures.     

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.     

儿童Ⅲ型肱骨髁上骨折的早期闭合治疗及前臂缺血性肌挛缩的预防

目的:评价闭合手法复位治疗儿童肱骨髁上骨折的疗效及早期对前臂缺血性肌挛缩的预防。方法:自2008年9月至2011年9月采用手法复位石膏外固定治儿童Ⅲ型肱骨髁上骨折38例,其中男20例,女18例;年龄2～13岁,平均7.5岁;伤后至就诊时间0.5h～6d,平均1.8d。伸直尺偏型20例,伸直桡偏型17例,屈曲型1例,均不伴神经动脉损伤。骨折早期,正确处理肿胀,采用手法复位、医用护肩配合上肢宽石膏托外固定,根据原始移位方向决定固定体位,定期拍X线片复查,发现再移位者,于术后1～2周内及时调整复位。平均4～6周后根据骨折愈合情况拆除石膏,指导肘关节功能锻炼。根据Dodgt疗效评价标准对肘关节功能进行评定。结果:38例均获随访,时间3个月～1年,平均7个月,骨折全部愈合。采用Dodgt疗效评价标准对患肘关节功能进行评估,优14例,良19例,可4例,差1例。结论:对未合并血管神经损伤的儿童肱骨髁上骨折采用闭合手法复位、医用护肩配合上肢宽石膏托外固定治疗可获得比较满意的临床疗效,早期重视并正确处理肿胀,注意石膏固定角度,可有效预防前臂缺血性肌挛缩的发生。     

Treatment of flexion-type supracondylar humeral fracture in children

PURPOSE: To assess the results of treatment for flexion-type supracondylar humeral fracture in children. METHODS: The treatment of 14 children with flexion-type supracondylar humeral fracture was reviewed. Severity was classified according to the Gartland system for extension-type fractures. Type-I fractures were treated with immobilisation in an extension cast. For type-II and -III fractures, closed reduction was first attempted followed by percutaneous pinning. If closed reduction failed, open reduction and internal fixation was performed. RESULTS: Patients were followed up for at least one year (range, 14-36 months). Treatment results were excellent in 7 patients, good in 4, fair in 3, and poor in none. Patients were pain-free and satisfied and none suffered any activity restriction. CONCLUSION: Closed reduction and percutaneous pinning is a good treatment option for type-II and -III flexion-type supracondylar humeral fractures.     

伸直位石膏夹板固定治疗儿童肱骨髁上骨折

目的:探讨非手术治疗儿童肱骨髁上骨折预防肘内翻畸形的有效方法。方法:自1992年5月至2013年12月,采用手法复位伸直位石膏夹板外固定治疗无神经血管损伤的儿童肱骨髁上骨折319例,男253例,女66例;年龄1岁3个月～13岁,平均6.7岁。伸直型肱骨髁上骨折284例,屈曲型肱骨髁上骨折35例。左侧167例,右侧152例。受伤至治疗时间1 h～7 d,平均1.8 d.不包括神经血管损伤病例及手术病例。结果:所有患者获得随访,时间3个月～14年,平均37.3个月。所有患儿获得骨性愈合,骨折愈合时间6～8周,平均6.9周。无严重肘内翻畸形、血管神经损伤或Volkmann挛缩等并发症发生。183例提携角与自身健侧一致,在5°～15°范围内,105例提携角较自身健侧有不同程度的减小,26例在复位时即有尺偏者提携角在-5°～0°,5例在复位时即有桡偏者提携角在15°～18°,基本不影响外观。所有病例肘关节活动度正常。结论:肘关节伸直位石膏夹板固定对预防儿童肱骨髁上骨折非手术治疗后的肘内翻畸形具有一定价值,希望有更多学者做进一步的研究。     

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.