儿童Gart landⅣ型肱骨髁上骨折的治疗

目的探讨儿童GartlandⅣ型肱骨髁上骨折的治疗方法及疗效。方法回顾性分析手术治疗的8例GartlandⅣ型肱骨髁上骨折,在72 h内行闭合或切开复位克氏针固定。结果 8例均获得随访,骨折均在8~12周获骨性愈合。肘关节功能评价参照Flynn等临床功能评定标准,肘关节功能均恢复良好。至末次随访时未出现肘内翻、伤口感染等并发症。结论手术是治疗GartlandⅣ型肱骨髁上骨折的有效方法。     

两种方法治疗儿童GartlandⅢ型肱骨髁上骨折的Meta分析

目的 通过Meta分析比较闭合复位经皮克氏针内固定与切开复位克氏针内固定治疗儿童GardandⅢ型肱骨髁上骨折的疗效.方法 通过检索关于儿童GartlandⅢ型肱骨髁上骨折经皮克氏针内固定与切开复位克氏针内固定对照研究的4篇文章,采用循证医学Meta分析法对肘关节功能、提携角、术后并发症进行综合分析.结果 Meta分析发现,经皮克氏针内固定与切开复位克氏针内固定治疗儿童GartlandⅢ型肱骨髁上骨折在肘关节功能、提携角、术后并发症方面并无明显统计学差异.结论 儿童GartlandⅢ型肱骨髁上骨折首选闭合复位经皮克氏针固定,当闭合复位失败或伴有神经、血管损伤时可采用切开复位内固定治疗.     

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。     

肘内侧有限切开克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折

目的观察肘内侧有限切开交叉克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折的临床疗效。方法回顾性分析2009年10月-2014年10月采用该入路及内固定方式治疗的GartlandⅢ型儿童肱骨髁上骨折32例的骨折愈合及并发症发生情况。结果 32例中有30例获术后随访,随访时间为3~26个月,平均6个月。手术切口均Ⅰ期愈合,骨折愈合良好,愈合时间2~5个月,平均3.2个月。针道感染2例,肘内翻畸形1例,无医源性血管、神经损伤发生,无异位骨化、缺血性肌挛缩等并发症发生。肘关节功能按Flynn评价标准评定优良率为90%。结论肘内侧有限切开复位交叉克氏针内固定治疗GartlandⅢ型儿童肱骨髁上骨折具有创伤小、骨折固定牢靠、神经损伤风险低、切口隐蔽等优点,是治疗GartlandⅢ型儿童肱骨髁上骨折的一种可行的治疗方法。     

尺神经沟置针术式治疗儿童GartlandⅢ型肱骨髁上骨折

背景：交叉克氏针内固定是目前治疗儿童GartlandⅢ型肱骨髁上骨折的首选方法,但仍未从根本上解决并发症发生问题。目的：评价尺神经沟置针术式治疗儿童GartlandⅢ型肱骨髁上骨折的可行性及疗效。 方法：1998年1月到2010年10月采用尺神经沟置针术式治疗儿童GartlandⅢ型肱骨髁上骨折患儿144例,随访时检查环小指运动及感觉情况,测量双上肢长度、肘关节活动度,摄双肘正位片测量Baumann角或提携角。采用HSS肘关节功能评价法评分标准进行肘关节功能评定。 结果：144例患儿,随访14~85个月,平均60个月,根据HSS肘关节功能评定法行功能评价：优140例,良4例,无肘内翻和肘外翻畸形发生,无继发尺神经损伤,肢体无短缩。 结论：尺神经沟置针术式治疗儿童GartlandⅢ型肱骨髁上骨折可获得良好的肘关节功能及外观,预防了肘内翻畸形及继发尺神经损伤,且对骨骺生长发育无明显影响。     

驱血带辅助下经皮外侧克氏针固定治疗青少年GartlandⅢ型肱骨髁上骨折

目的探讨驱血带辅助下桡侧克氏针固定治疗青少年GartlandⅢ型肱骨髁上骨折的疗效。方法回顾性分析2016年9月~2018年3月收治的23例青少年GartlandⅢ型肱骨髁上骨折患者的临床资料,均为闭合性骨折,其中男14例,女9例,平均年龄12.4(10~15)岁。均行骨折端复位,驱血带维持肱骨远端复位,闭合复位经皮桡侧克氏针固定,术后长臂管型石膏固定4周,拆除石膏后进行肘关节屈伸功能锻炼。术后采用Flynn肘关节评分评估临床疗效。结果本组23例患儿均顺利完成闭合复位经皮桡侧克氏针固定,手术时间平均44(31~55)min。平均随访15.3(13~22)个月,所有患儿均获得骨性愈合,无一例出现血管神经损伤或克氏针断裂等并发症。末次随访未见肘内翻畸形,按Flynn功能评定标准:优22例,良1例,优良率100%。结论驱血带辅助下桡侧克氏针固定创伤小、复位稳定、肘内翻发生率低、医源性尺神经损伤少,是治疗青少年GartlandⅢ型肱骨髁上骨折的有效方法。     

内侧入路克氏针内固定治疗儿童肱骨髁上骨折

目的评价肘内侧入路克氏针内固定治疗儿童GartlandⅢ型肱骨髁上骨折的临床疗效。方法采用肘内侧入路、克氏针内固定、石膏外固定治疗86例GartlandⅢ型肱骨髁上骨折患儿。结果 86例均获随访,时间5-36个月。骨折全部愈合。无一例发生内固定移位;2例于术后出现轻度肘内翻畸形。肘关节功能根据F lynn评价标准：优81例,良5例。3例合并神经损伤患者6个月康复。无Volkmann缺血性肌挛、骨化性肌炎、缺血性肌坏死等并发症。结论肘内侧入路交叉克氏针内固定创伤小、并发症少且内固定可靠,是治疗儿童肱骨髁上骨折安全有效的方法。     

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。     

儿童严重型肱骨髁上骨折的手术治疗

目的 探讨儿童严重型肱骨髁上骨折的手术治疗及其疗效评价. 方法 回顾性分析2001年6月至2006年6月手术治疗的316例儿童严重型肱骨髁上骨折,男215例,女101例,年龄1～14岁,平均7岁.左侧167例,右侧149例.全部采用切开复位克氏针内固定,术后石膏固定,2～4周后进行功能训练. 结果 随访316例,随访时间6个月～5年,平均2年10个月.按Flynn标准对术后肘关节功能恢复情况进行评价:优253例,良34例,可25例,差4例,优良率90.8%.发生肘内翻27例. 结论 儿童严重型肱骨髁上骨折手法复位失败、开放性骨折、神经血管损伤及影响肘关节功能等严重病例应采用手术治疗,解剖复位骨折断端、克氏针内固定,术后早期进行肘关节功能锻炼,对于提高手术治疗效果、防止或减少肘内翻畸形等并发症的发生有重要意义.     

肘横纹小切口复位治疗儿童GartlandⅢ型肱骨髁上骨折

目的探讨肘横纹小切口复位治疗儿童GartlandⅢ型肱骨髁上骨折的临床疗效。方法对30例儿童GartlandⅢ型肱骨髁上骨折采用肘横纹小切口复位内外髁交叉克氏针内固定治疗。记录肘关节活动度及并发症发生情况。采用Flynn肘关节功能评分标准评价疗效。结果患儿均获得随访,时间3~18个月。骨折均达骨性愈合,时间3~6周。无Volkmann缺血性肌挛缩、骨化性肌炎、神经损伤、肘内翻或外翻畸形等并发症发生。末次随访时,肘关节屈曲140°~150°、伸直0°~8°,前臂旋前80°~90°、旋后75°~80°;根据Flynn肘关节功能评分标准评价疗效:优28例,良2例。结论肘横纹小切口复位治疗儿童GartlandⅢ型肱骨髁上骨折具有创伤小、复位效果好、骨折愈合率高、并发症少、肘关节功能恢复良好等优点。     

Post-traumatic cubitus varus in children (apropos of 8 cases in African children)]

The author describes his experience after treatment of 8 cases of cubitus varus secondary to displaced supracondylar fractures of the humerus in African children. Measurement of the Baumann angle is necessary for the assessment of cubitus varus. The median angle is 24 degrees with a range of 10 degrees to 45 degrees. Indications were dictated by functional problems, discomfort, and esthetic considerations. The surgical treatment consisted in a supracondylar osteotomy of the humerus for correction of cubitus varus.     

Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation

Objective: Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury.Methods: We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus (Gartland type Ⅲ) with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours.Results: Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann's angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn's criteria,38 patients (95%) had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus.Conclusion: Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation.     

经皮撬拨复位双克氏针内固定联合石膏托治疗儿童GartlandⅢ型肱骨髁上骨折

目的：观察经皮撬拨复位双克氏针内固定联合石膏托治疗儿童GartlandⅢ型肱骨髁上骨折的临床疗效。方法：自2007年6月至2008年12月,采用经皮撬拨复位双克氏针内固定联合石膏托治疗儿童GartlandⅢ型肱骨髁上骨折27例。男18例,女9例;年龄6～12岁,平均8.1岁。伸直型15例,屈曲型12例;尺偏型14例,桡偏型13例。伤后就诊时间0.5～8d,平均3.6d。结果：27例均获随访,时间6～24个月,平均13.5个月。所有骨折均于术后4～6周愈合,平均愈合时间4.5周。未出现内固定物松动和骨折再移位,无Volkmarm挛缩、针眼或深部感染、尺神经损伤、骨化性肌炎等并发症。术后发生肘内翻畸形2例,但内翻角均不超过15°,可能为过早拆除外固定和不适当功能锻炼所致。按Flynn标准评定,结果优19例,良5例,可2例,差1例。结论：C形臂X线机透视下闭合复位经皮克氏针内固定治疗儿童不稳定肱骨髁上骨折手术创伤小,固定可靠,可以获得良好的肘关节功能和外形。     

Evaluation of the role of pin fixation versus collar and cuff immobilisation in supracondylar fractures of the humerus in children

Long term results of children with supracondylar humeral fractures treated with manipulation and strapping and manipulation followed by pin fixation were evaluated. Forty patients were regarded as Gartland type II injuries. 33 of these were treated with closed reduction and collar and cuff immobilisation and 7 with closed reduction and percutaneous pinning. Two cases of cubitus varus were reported one from each treatment modality. Forty-four patients were included as Gartland type III injuries. Of these 14 were treated with closed reduction and collar and cuff immobilisation, 25 with closed reduction and percutaneous pinning and five with open reduction and pinning. There were two cases of cubitus varus and one case of cubitus valgus following pin fixation. In addition one case of extension lag and one significant ulnar nerve neurapraxia was recorded following pin fixation. One case of cubitus varus was seen following manipulation and collar and cuff treatment. There was no statistical difference between either treatment modality in terms of predicting a better outcome (p0.05).We conclude that pin fixation has no advantages over simple immobilisation in certain Gartland II and III type injuries. Although pin fixation is beneficial in unstable injuries collar and cuff immobilisation continues to have an important role in the treatment of stable supracondylar fractures.     

鹰嘴牵引加石膏固定治疗儿童肱骨髁上GartlandⅢ型骨折

目的 探讨鹰嘴牵引加石膏固定治疗儿童肱骨髁上GartlandⅢ型骨折的临床疗效。方法98例儿童肱骨髁上GartlandⅢ型骨折者均行尺骨鹰嘴牵引治疗3～5d后，在麻醉下手法复位加石膏外固定3～4周，并分期功能锻炼。结果98例均获随访，时间12～24个月，参照Flynnetal标准：优72例，良22例，可3例，差1例，优良率为95．9％。无严重肘内翻畸形发生。11例合并神经损伤患儿治疗后按Frankel分级：B级2例恢复至D级1例，1例无恢复；C级4例恢复至D级1例、E级3例；D级5例均恢复至E级。B级1例无恢复者术后3个月经对症治疗后恢复至D级。结论该方法操作简便，安全可靠，疗效确切，并发症少。     

Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-IV fracture

BACKGROUND: There is an uncommon subset of supracondylar humeral fractures in children that are so unstable they can displace into both flexion and extension. The purposes of this study were to describe this subset of supracondylar fractures and to report a new technique of closed reduction and percutaneous pinning for their treatment. METHODS: In a retrospective review of 297 consecutive displaced supracondylar humeral fractures in children treated operatively at our institution, we identified nine that were completely unstable with documented displacement into both flexion and extension as seen on fluoroscopic examination with the patient under anesthesia. We used a new technique for closed reduction and fixation of these fractures, and then we assessed fracture-healing and complications from the injury and treatment. RESULTS: All nine fractures were treated satisfactorily with closed reduction and percutaneous pinning. The complication rate associated with these unstable fractures was no higher than that associated with the 288 more stable fractures. Seven of the nine fractures were stabilized with lateral entry pin placement, and two fractures were stabilized with crossed medial and lateral pins. None of the patients had a nonunion, cubitus varus, malunion, additional surgery, or loss of motion. CONCLUSIONS: In rare supracondylar fractures in children, multidirectional instability results in displacement into flexion and/or extension. This fracture can be classified as type IV according to the Gartland system, as it is less stable than a Gartland type-III extension supracondylar fracture. These fractures can be treated successfully with a new technique of closed reduction and percutaneous pinning, thus avoiding open reduction.     

改良手术入路转移植骨内固定治疗儿童肱骨髁上骨折

目的观察改良手术入路转移植骨内固定治疗儿童肱骨髁上骨折的临床疗效及预防肘内翻的作用。方法 2005年1月～2010年12月,采用肘后"S"形正中纵切口改良手术入路,取自肱骨髁上骨折桡侧近断端薄层骨片或骨碎片植于同骨折部尺侧处,克氏针交叉内固定,治疗儿童肱骨髁上骨折GartlandⅢ型15例。结果 15例均获随访,平均时间30(12～48)个月;术后肘关节功能按Flynn等临床功能评定标准:优14例,良1例。无肘内外翻畸形。结论该术式暴露充分,不增加受伤组织的"再损伤",直视下复位、固定、植骨;操作简单,手术风险小,功能恢复好;在预防肘内翻畸形方面,可取得比较满意的临床效果。