矫枉过正治疗小儿尺偏型肱骨髁上骨折

目的:评定桡偏复位经皮穿针内固定治疗小儿尺偏型肱骨髁上骨折的临床疗效。方法:小儿尺偏型肱骨髁上骨折213例(男183例,女30例;年龄1~15岁,平均6.4岁),伸直型211例,屈曲型2例。所有患者均采用手法复位达桡偏约10°,配合经皮穿针内固定治疗。结果:术后3周去除内外固定,4~6周肘关节功能恢复,随访2~5年,参照Flynn标准,自拟评价标准,本组优132例,良77例,可4例,优良率达98.1%。结论:矫枉过正配合经皮穿针内固定治疗小儿尺偏型肱骨髁上骨折复位与固定操作简便,患肢功能恢复好,可有效预防肘内翻畸形。     

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。     

闭合复位经皮交叉克氏针内固定治疗儿童肱骨髁上骨折

目的 探讨闭合复位经皮交叉克氏针内固定治疗儿童肱骨髁上骨折的临床疗效. 方法 2006年1月至2011年6月共收治162例儿童肱骨髁上骨折患者,男90例,女72例;年龄2～14岁,平均7.1岁.骨折Gartland分型:Ⅱ型98例,Ⅲ型64例.患儿受伤至就诊时间为lh至3d,平均24 h.首先采用闭合手法复位经皮2枚交叉克氏针内固定.对于闭合复位效果不满意的患儿,再行切开复位内固定进行治疗.术后6个月参照Flynn肘关节功能评分标准评定疗效. 结果 162例患儿术后获9 ～ 60个月(平均37个月)随访.所有患者骨折愈合时间平均为4.5周(4～6周).术后6个月参照Flynn肘关节功能评分标准评定疗效:优138例,良19例,差5例,优良率为96.9％.主要并发症包括肘内翻3例、肘外翻2例、骨化性肌炎1例、尺神经损伤1例. 结论 闭合复位交叉克氏针内固定方法操作简便、创伤小、骨折固定稳定可靠及疗效良好,是治疗儿童肱骨髁上骨折简单、实用的有效方法之一.     

经皮交叉克氏针固定治疗移位型儿童肱骨髁上骨折的临床疗效观察

目的 探讨移位型儿童肱骨髁上骨折采用经皮交叉克氏针固定的治疗效果并评估相关的危险因素.方法 对采用经皮内外侧交叉克氏针固定治疗的64例移位型儿童肱骨髁上骨折进行回顾,根据Flynn肘关节评定标准及并发症情况,分析治疗效果及相关危险因素.结果 所有骨折均达到骨性愈合,肘关节功能及外观满意,无严重并发症发生.结论 经皮交叉克氏针固定维持复位确切、并发症较少,是治疗移位型儿童肱骨髁上骨折的安全、有效方法.     

儿童肱骨髁上骨折骨牵引与闭合复位内固定的疗效比较

目的比较尺骨鹰嘴骨牵引与闭合复位经皮穿针内固定治疗儿童伸直型肱骨髁上骨折的临床效果。方法对102例伸直型肱骨髁上骨折患儿分别采用手法整复配合骨牵引治疗(牵引组,51例)和闭合复位内固定治疗(闭合复位内固定组,51例)。结果患儿均获得随访,时间12～24个月。术后3个月按Flynn肘关节功能评价标准进行疗效评定:牵引组优良率98. 0%,闭合复位内固定组优良率98. 0%,两组优良率相同。结论尺骨鹰嘴骨牵引治疗操作简单、创伤小,对于伸直型骨折尤其对于学龄期前后儿童治疗效果明确。     

有限切开克氏针内固定治疗手法复位失败的儿童肱骨髁上骨折

目的：探讨儿童肱骨髁上骨折手法复位失败后采用肘外侧有限切开复位经皮内外侧3针交叉内固定治疗的方法及疗效。方法对19例麻醉下手法复位失败的儿童肱骨髁上骨折患者行肘外侧有限切开,去除影响复位因素后再次复位,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°位、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°位制动3周。结果19例均获随访,时间6～36个月。出现肘部前侧局限性骨化1例,肘关节周围弥散性骨化1例。按 Flynn 标准评定疗效：优13例,良3例,一般2例,差1例。结论肘外侧有限切开复位内外侧3针交叉固定治疗手法复位失败的儿童肱骨髁上骨折创伤小,疗效满意。     

闭合手法复位钢针内固定治疗少儿肱骨髁上骨折

目的探讨少儿各种移位的肱骨髁上骨折行闭合手法复位后钢针三维内固定治疗的效果。方法对1 200例有移位肱骨髁上骨折患儿均采用闭合手法复位后钢针三维内固定。结果疗效依据Flynn疗效标准评价:优秀1 090例(90.83%),良好80例(6.67%),可18例(1.5%),差12例(1%),优良率为97.5%。结论闭合手法复位后钢针三维内固定治疗少儿各种移位的肱骨髁上骨折,可使骨折复位,愈合良好,功能恢复满意,并能有效预防肘部畸形的发生。     

闭合复位经皮穿针固定治疗儿童肱骨髁上骨折

目的探讨采用闭合复位经皮穿针固定治疗儿童肱骨髁上骨折的疗效。方法自2002年1月至2008年6月应用C型臂X线机透视下闭合复位经皮穿针内固定治疗儿童肱骨髁上骨折53例,骨折分型:GartlandⅡ型31例,Gart-landⅢ型22例。其中闭合性骨折48例,开放性骨折5例。合并神经损伤9例,其中桡神经损伤3例,正中神经损伤4例,尺神经损伤2例,术前检查均为不完全损伤。结果53例均获得随访,随访时间6~18个月,平均11个月。所有骨折均于术后4~6周愈合,平均愈合时间4.5周,未发生骨折延迟愈合。未出现内固定物松动、脱出和骨折再移位,无发生Volkmann挛缩、针眼或深部感染、骨化性肌炎等并发症。合并不完全神经损伤的9例,经对症治疗全部恢复。按疗效标准评定,结果优36例,良12例,可3例,差2例,优良率90.6%。结论闭合复位经皮穿针内固定治疗儿童肱骨髁上骨折,手术损伤小,不切开组织,减少了对骨周围组织的损伤,使骨折易于愈合,又减少患者痛苦及感染机会,而且可预防Volkmann挛缩和肘内翻的发生,是目前治疗儿童移位型肱骨髁上骨折较好的治疗方法。     

闭合复位经皮穿针内固定治疗肱骨髁上移位骨折

闭合复位经皮穿针内固定治疗肱骨髁上移位骨折甘肃省中医院（７３００５０）赵继荣，高辉，路焕光自１９９２年３月～１９９３年１０月，采用臂丛麻醉，手法复位，经皮克氏针内固定，前臂石膏托外固定收治肱骨髁上移位骨折３０例，获得满意疗效，现报告如下。临床资料本组...     

超声引导下手法复位经皮交叉穿针固定治疗儿童移位型肱骨髁上骨折

目的:探讨利用超声技术引导复位以及探查尺神经位置,经皮交叉穿针固定治疗移位型儿童肱骨髁上骨折的临床疗效。方法:回顾性分析2017年12月至2018年12月收治的45例移位型肱骨髁上骨折手术患儿的临床资料,其中男26例,女19例;年龄1岁3个月～11岁4个月,平均7.6岁;摔倒伤44例,坠落伤1例;左侧29例,右侧16例;GartlandⅡ型12例,Ⅲ型33例;受伤至手术时间4h～7d,平均2.5d;患儿均无神经及血管损伤。利用超声对患儿骨折复位进行引导,并行交叉穿针固定,其中内侧穿针时,使用超声探测尺神经位置以避免损伤尺神经。术中观测尺神经状态,末次随访时采用Flynn临床功能评定标准对患儿肘关节功能及美观度进行评价,并观察术后并发症情况。结果:术中使用超声分别从肱尺关节内侧面、肱桡关节外侧面以及肱尺关节矢状面3个方向对骨折端进行探查,可指导骨折复位,并可清楚探查尺神经位置,避免内侧穿针时出现尺神经损伤。患儿术后均获得随访,时间6～12个月,平均9个月。术后未出现复位丢失,骨折均愈合,愈合时间4～6周,平均5周。末次随访时根据Flynn评估标准:同健侧相比,41例患侧屈伸受限0。～5。,临床评定为优;3例屈伸受限6°～10°,临床评定为良;1例屈伸受限11°～15°,临床评定为可。同健侧相比,40例患侧提携角丢失0。～5。,临床评定为优;5例提携角丢失6°～10°,临床评定为良。术后均未出现尺神经损伤、肘内外翻畸形等并发症。结论:虽然目前超声引导治疗移位型儿童肱骨髁上骨折对操作者有较高要求,但其具有对软组织可清晰显影、便携、有效、对健康无影响等优点,在术中可清晰探查骨折情况,引导骨折复位,并可准确显示尺神经位置,有效提高内侧穿针安全性,从而最大程度减少并发症的发生。因此,超声引导手法复位经皮交叉穿针固定治疗移位型儿童肱骨髁上骨折有效且值得进一步推广。     

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fract     

肱骨髁上骨折治疗方法改进及并发症防治的探讨

通过改进后的方法治疗肱骨髁上骨折以预防和降低肘内翻的发生。方法：肱骨髁上骨折197例,男167例,女30例;年龄3～12岁,平均8．7岁;伸直型179倒,屈曲型18例;其中开放性骨折6例。单纯石膏托外固定34例,手法复位、石膏外固定53例,牵引复位、石膏外固定23例,手术治疗87例。手术者中29例采用肘前外侧切口,58例采用后内侧切口。结果：197例中191例得到随访,时间1-5年,平均3．7年,参考小儿肱骨髁上骨折相关疗效评定,优142例,良27例,可13例,差9例,肘内翻发生8例。结论：肘内翻发生虽有其客观因素,但治疗时只要彻底纠正尺偏倾斜并维持复位后的稳定,可使肘内翻发生率降到最低限度。     

术中撬拨复位经皮交叉克氏针固定治疗儿童不稳定性屈曲型肱骨髁上骨折

目的 探讨术中撬拨复位经皮交叉克氏针固定治疗儿童不稳定性屈曲型肱骨髁上骨折的疗效。方法 回顾性分析我院2015年1月至2019年6月收治的27例不稳定性屈曲型肱骨髁上骨折手法复位失败的儿童的临床资料,男13例,女14例;年龄为2~14岁,平均7.31岁。按照骨折移位程度分型,完全移位断端接触17例,完全移位断端无接触10例。合并尺神经损伤5例,均为闭合性损伤。所有病人在手法复位失败后均采用术中撬拨复位经皮交叉克氏针固定治疗。术后4~6周拔出克氏针,记录并发症发生情况,术后6个月参照Flynn肘关节功能评分标准评定疗效。结果 病人手术时间为15~50 min,平均30 min。病人术中均覆盖防辐射铅衣保护,术中透视5~8次,平均7.5次。术后随访12~36个月,平均24个月。病人骨折愈合时间为4~6周,平均4.5周,术后3个月尺神经损伤均恢复。术后6个月参照Flynn肘关节功能评分标准评定疗效：优20例,良6例,可1例,优良率为98.8%（26/27）。所有病人均未发生肘内翻、骨化性肌炎、医源性神经损伤。结论 撬拨复位经皮交叉克氏针固定是治疗儿童不稳定性屈曲型肱骨髁上骨折手法复位失败后的较为理想的复位方法。     

Closed reduction with percutaneous Kirschner wire drill-and-pry for pediatric supracondylar humeral fractures with bony callus formation and delayed presentation

BackgroundSupracondylar humeral fractures are the most common type of pediatric elbow fractures, and are primarily treated using closed reduction and percutaneous pinning. For patients who are treated ≥14 days after the injury, after callus formation has occurred, closed reduction is usually not possible. The purpose of this study is to report the clinical outcomes of closed reduction with percutaneous Kirschner wire (K-wire) drill-and-pry for the delayed treatment of pediatric supracondylar humeral fractures with bony callus formation.MethodsWe retrospectively reviewed the data of 16 patients who underwent percutaneous K-wire drill-and-pry between November 2019 and August 2021 for the treatment of supracondylar humeral fractures with bony callus formation ≥14 days after the injury. Clinical outcomes were assessed using the Flynn criteria. The postoperative Baumann angle and pin configuration were evaluated using x-ray examinations.ResultsAll patients were followed up for 8–28 months (average, 16.63 months). The fractures healed in 4–6 weeks (average, 4.38 weeks). The operative time ranged from 10 to 124 min (average, 35.12 min). No iatrogenic vascular or nerve injury occurred. No patient developed cubitus varus. According to the Flynn criteria, 12 patients had excellent outcomes, 2 patients had good outcomes, 1 patient had a fair outcome and 1 patient had a poor outcome.ConclusionClosed reduction with percutaneous K-wire drill-and-pry is a mini invasive technique for supracondylar humeral fractures with bony callus formation in children. Most patients had a good clinical and cosmetic outcomes without scarring.     

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.     

Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children.

A retrospective review of 29 children with displaced supracondylar humerus fractures was performed. Fifteen patients treated with closed reduction and percutaneous pinning and 14 patients treated with open reduction and percutaneous pinning were evaluated at a minimum of 18 months (range 18-80 months). Results were graded according to the criteria of Flynn et al. (Flynn JC, Matthews JG, Benoit RL: Blind pinning of displaced supracondylar fractures of the humerus in children. J Bone Joint Surg [Am] 56:263-272, 1974) using both cosmetic and functional evaluations. Excellent or good results were obtained in 14 of the 15 fractures treated with closed reduction and percutaneous pinning and in 12 of the 14 fractures treated with open reduction and percutaneous pinning. The three fair cosmetic results were associated with inadequate reduction and residual medial angulation. Ten to 15 degrees of motion loss occurred in three older patients. One patient in each group had a minor pintract infection. There were no cases of iatrogenic nerve injury or myositis ossificans. The treatment goal in displaced supracondylar humerus fractures in children is anatomic reduction. If an anatomic reduction cannot be achieved with closed reduction, open reduction is indicated. This can be done without an increased risk of complications.     

不同类型儿童肱骨髁上骨折的治疗探讨

目的探讨不同类型儿童肱骨髁上骨折的治疗方法。方法对GartlandⅠ型骨折,单纯应用石膏外固定;GartlandⅡ型和Ⅲ型骨折,选择闭合复位、经皮穿针内固定;对于闭合复位、经皮穿针失败或伴有明显血管、神经损伤症状以及患肢肿胀特别严重的病例,采用切开复位克氏针内固定。结果未出现骨筋膜室综合征、血管或神经受损等并发症。术前合并神经损伤的病例,其神经功能得以完全恢复。56例随访16~28个月,平均20.6月,按F lynn功能评价标准,优38例,良16例,可1例,差1例。结论针对不同类型儿童肱骨髁上骨折采取相应的治疗方法,疗效满意。     

Ipsilateral supracondylar humerus fracture and Monteggia lesion: a case report

Two to 13% of supracondylar humerus fractures in children are associated with an ipsilateral forearm fracture, most of which are distal radius fractures. We present an unusual case of a 2-year-old girl with an ipsilateral supracondylar humerus fracture and a Monteggia lesion. Our management consisted of percutaneous K-wire fixation of the supracondylar humerus fracture and percutaneous insertion of an intramedullary K-wire for stabilization of the ulna fracture. Our patient had an excellent result, and we would recommend this method of fixation for similar injuries.     

Treatment of displaced supracondylar fractures of the humerus in children at the orthopaedic ward of the Children's Hospital in Kielce]

Ninety five children in age from 4 to 12 years (61 boys and 34 girls) with displaced supracondylar distal humerus fractures were treated at the orthopaedic ward of The Children's Hospital in Kielce between I 2000-XII 2001. The method of choice was closed reduction and percutaneous fixation with Kirschner wires (74 children). We also used closed reduction and application of an above elbow cast (12 children), skeletal traction with fixation after swelling resignation (5 children), and open reduction and internal fixation (4 children). In 90 cases we did not observe any neurovascular disorders, and early functional results were good or satisfactory. 2 cases were associated with transient, postreduction radial nerve palsy. In 2 children surgical intervention was necessary due to external compression of the brachial artery in one case, and contusion with brachial artery spasm in another. In one girl we observed development of Volkmann's contracture (treated surgically with good functional result). The authors conclude that the closed reduction and percutaneous K-wire fixation can be used as a treatment of choice for displaced supracondylar fractures of the humerus in children.