石膏或夹板外固定治疗移位肱骨髁上骨折近期临床疗效分析

目的：探讨手法复位石膏或夹板外固定治疗Gartland Ⅱ、Ⅲ型肱骨髁上骨折的临床疗效。方法：回顾性分析2007年3月至2009年9月应用手法复位石膏或夹板外固定治疗Gartland Ⅱ、Ⅲ型肱骨髁上骨折的病例资料,其中男18例,女15例;年龄3～12岁,平均6.4岁。骨折均为伸直型,Gartland Ⅱ型21例,Ⅲ型12例。分析术前、术后X线片,对肘关节功能进行Flynn肱骨髁上骨折分级评定,记录并发症的发生情况。结果：33例均获随访,时间3～12个月,平均6.8个月。33例均手法复位成功,14例有肘关节周围不同程度的张力性水疱,9例由于张力性水疱影响石膏或夹板外固定发生骨折再次移位,5例择期静脉麻醉下行闭合复位克氏针内固定,4例行尺骨鹰嘴骨牵引治疗。患儿最后一次随访时Flynn肱骨髁上骨折评定分级：优11例,良16例,一般4例,差2例。结论：手法复位石膏或夹板外固定仍是治疗肱骨髁上骨折的重要方法,肘关节过度屈曲位固定虽然可以提供骨折断端较稳定的固定,但一定要密切观察患肢远端血运及肘关节周围皮肤情况,及时调整治疗策略预防并发症。     

微创手术治疗儿童肘关节内骨折

<正> 肱骨内髁骨折,肱骨外髁骨折,肱骨髁上骨折可称为肘关节内骨折,占儿童骨折的大多数,其治疗分保守疗法及手术疗法两类。近年来,我科在X线直视下采取手法复位、闭合穿针、小夹板或石膏托外固定术治疗上述三种骨折共42例,效果良好,现报道如下。     

外展架鹰嘴牵引治疗不稳定肱骨髁上及髁间骨折

肱骨髁上及肱骨髁间骨折,前者多见于儿童,占全部骨折发病率的7.48%；后者多见于成人,占全部骨折发病率的0.48%。有一部分不稳定的肱骨髁上及髁间骨折的治疗效果较差,主要因为达不到理想的手法复位或小夹板及石膏固定难以维持良好的对位而又发生移位,使骨折畸形愈合严重影响肘关节功能。     

小儿肱骨髁上骨折治疗方法的体会

我院自 1 992～ 1 999年采用不同方法治疗肱骨髁上骨折 1 98例 ,除陈旧性骨折及神经血管损伤需手术治疗外 ,其余均采用手法复位 ,尺骨鹰嘴牵引及小夹板外固定 ,效果满意。其中尺骨鹰嘴牵引及小夹板外固定 ,可较好预防缺血性肌挛缩及肘内翻畸形。肱骨髁上骨折 ,是小儿肘部最常见骨折之一 ,约占全身骨折的 2 6.7% ,占儿童肘部骨折的 60 %～70 % ,多发年龄 5～ 1 2岁 ,见于运动伤、生活伤和交通事故 ,系间接暴力所致 ,其并发症最常见肘内翻畸形 ,缺血性挛缩 ,肘关节功能障碍。本文着重就尺骨鹰嘴牵引及小夹板外固定的治疗方法 ,肘内翻 ,缺血性…     

手法复位小夹板固定治疗小儿肱骨髁上骨折预防肘内翻的体会

目的探讨采用手法复位小夹板外固定预防小儿肱骨髁上骨折肘内翻。方法对小儿伸直型肱骨髁上骨折195例,骨折类型全部为闭合性伸直型骨折,桡偏型62例,尺偏型84例,旋转型49例,采用手法复位小夹板外固定。结果本组获随访6～30个月,骨折全部愈合,疗效评价结果:优146例,良31例,可13例,差5例,优良率为90.8%。发生需手术矫正的肘内翻12例,占6.2%。结论良好的手法复位小夹板外固定是预防肱骨髁上骨折肘内翻的有效方法。     

院前早期处理失误肱骨髁上骨折52例的治疗与分析

肱骨髁上骨折是儿童常见的肘部骨折,大都经过正确的治疗可取得良效,但若早期处理失误又未能及时纠正,将可能导致严重后果.1985年5月～1993年5月,我们收治因早期院外处理失误的肱骨髁上骨折52例,采用患肢牵引,手法复位,石膏和小夹板固定,部分病例行前臂切开减张,骨折复位单克氏针内固定,取得一定疗效,报告如下:     

手法复位结合中药熏洗治疗伸直型肱骨髁上骨折76例疗效分析

目的探讨手法复位结合中药熏洗治疗伸直型肱骨髁上骨折的临床疗效。方法 76例肱骨髁上骨折均采取早期手法复位,石膏托外固定,4周后去石膏托,中药熏洗,进行肘关节功能锻炼。结果 76例患儿有6例复位失败,1例骨折再移位改手术切开复位内固定,其余69例均达到解剖复位或近解剖复位。有62例获得随访,60例无肘关节功能影响及肘内翻发生,有2例肘关节功能轻度影响,伸屈在10°～130°之间。结论手法复位结合中药熏洗治疗伸直型儿童肱骨髁上骨折疗效显著。     

经皮克氏针固定治疗儿童肱骨髁上骨折37例

自2003年3月至2006年3月,采用闭合手法复位、经皮克氏针交叉固定,配合石膏托外固定治疗新鲜移位型肱骨髁上骨折37例,疗效满意,现总结报告如下。     

儿童移位性伸直型肱骨髁上骨折治疗方法的选择

肱骨髁上骨折是儿童肘部最常见的骨折.最常用的治疗方法是闭合复位,石膏托外固定,牵引,闭合复位经皮克氏针内固定和切开复位内固定.移位骨折的治疗问题很多,包括神经、血管损伤,获得和维持复位困难,以及肘关节僵硬或肘内翻畸形.本文就1990年1月至1996年9月93例移位性伸直型肱骨髁上骨折不同方法治疗的结果进行报道.     

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。     

闭合复位石膏托固定加石膏外牵引治疗儿童肱骨髁上骨折的病例对照研究

目的：比较闭合复位石膏托固定加石膏外牵引疗法与手术治疗无神经血管合并症的儿童闭合性Gart-landⅢ型肱骨髁上骨折的临床疗效。方法：自2009年6月至2012年6月,对151例儿童无神经血管损伤合并症的闭合性肱骨髁上骨折的临床资料进行回顾性分析,骨折均为GantlandⅢ型,其中男87例,女64例;年龄1～12岁,平均5．3岁。采用闭合复位石膏托外固定治疗76例（保守组）,手术切开复位克氏针内固定75例（手术组）。记录并对比分析两组的骨折愈合时间、肘关节功能锻炼时间、肘关节功能恢复情况;采用Flynn肘关节功能评分标准对临床疗效进行评定。结果：151例患儿均获随访,平均18.3个月（6～36个月）。保守组的骨折愈合时间及功能锻炼时间明显短于手术组（P〈0．001）。两组肘关节屈伸活动度丢失量及提携角比较差异无统计学意义（P〉0．05）。采用Flynn等评定标准对临床疗效进行评估：保守组优31例,良35例,可7例,差3例;手术组优27例,良30例,可17例,差1例;两组疗效比较差异无统计学意义（P〉0．05）。结论：闭合复位石膏托固定加石膏外牵引治疗无神经血管损伤合并症的儿童闭合性Gart-landⅢ型肱骨髁上骨折,疗效与手术治疗相当,骨折愈合时间短,便于早期锻炼肘关节,是一种较为理想的治疗选择。     

Supracondylar fractures of the humerus in children: analysis of the results in 142 patients

One hundred forty-two children who had supracondylar humerus fractures and who were treated either by open reduction and internal fixation or by closed methods were reviewed. There were 104 boys and 38 girls. Their ages ranged between 2 and 14 years, with an average age of 8 years. One hundred thirteen of the fractures were of the extension type and 29 were of the flexion type. Sixty-two patients were treated by manipulative reduction and immobilization in a plaster of Paris cast, and 20 were treated by overhead skeletal traction followed by the application of a plaster of Paris cast. The other 60 patients were treated by open reduction and internal fixation. The follow-up period ranged from 4 years to 11 years, with an average of 7.5 years. The results were evaluated based on the range of motion, the subsequent deformity, if any, and the carrying angle. In the overall series we had 72 (50.70%) excellent, 31 (21.83%) good, 13 (9.15%) fair, and 26 (18.30%) poor results.     

Completely displaced supracondylar fracture of the humerus in children. A review of 1708 comparable cases

The displaced supracondylar fracture of the humerus in children is a very difficult injury to treat. Manipulation and splint immobilization is perhaps the most common method. A review of the literature on 1708 comparable cases revealed that several different treatments were used. The worst results occurred with manipulation and splint immobilization alone. The best results occurred with traction techniques and well-performed Kirschner-pin transfixation, either open or closed. Complications such as Volkmann's ischemic contracture and myositis ossificans are rare. A completely displaced supracondylar fracture in a child should not be treated by manipulation and splint immobilization alone.     

外展位尺骨鹰嘴牵引治疗严重肿胀肱骨髁上骨折70例

目的观察外展位尺骨鹰嘴牵引治疗严重肿胀肱骨髁上骨折的疗效。方法从1993年7月～2001年7月对70例严重肿胀肱骨髁上骨折行尺骨鹰嘴牵引配合小夹板外固定治疗。结果术后获得随访为100％,随访时间1-4年,本全组优良率达到94．2％。结论尺骨鹰嘴牵引治疗严重肿胀肱骨髁上是骨折是一种简便有效的方法。并发症少,疗效好。     

Fracture of the tibia complicated by acute compartment syndrome

A consecutive series of 32 patients with tibia fractures complicated by compartment syndrome was treated with fasciotomy. One group was also treated with closed reduction of the fracture and cast immobilization and compared with a comparable group treated with internal fixation without case immobilization after fasciotomy. All other patients were treated with fasciotomy and reduction followed with either external skeletal fixation, pins and plaster, or skeletal traction. Care of the open fasciotomy incisions, observation of the neurovascular status of the limb, and rehabilitation of the extremity were facilitated by internal fixation operations without subsequent external cast immobilization. The anatomic and functional results in this group were better than those treated with fasciotomy and cast immobilization. All fractures were united by 20 weeks. Complications in both groups were similar, although one deep infection, which was resolved with appropriate treatment, occurred in the group treated with internal fixation. Six open tibia fractures were treated with external skeletal fixation after fasciotomy; the results were less satisfactory, but the initial injuries were also more severe in this group. Patients with closed tibial fractures complicated by compartment syndromes should be treated expeditiously with fasciotomy, followed by stable internal fixation.     

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。     

儿童移位肱骨髁上骨折的三级筛选式治疗

目的:制定儿童移位肱骨髁上骨折的规范化治疗方案,避免和减少并发症的发生。方法:对136例骨折中轻度肿胀的89例采用手法复位,失败的38例连同重度肿胀的42例采用骨牵引复位,牵引复位失败中的23例(10例拒绝手术治疗)连同陈旧性骨折的5例采用手术切开复位的三级筛选式治疗,并对其疗效进行分析评价。结果:手法复位成功51例,骨牵引后复位成功47例,手术切开复位成功28例。10例手法复位失败后拒绝手术治疗,后期发生肘内翻。随访136例,时间3~48个月,骨折均在3个月内愈合,肘内翻畸形26例,占19%。无筋膜间室综合征、伤口及针孔感染的发生。结论:三级筛选式治疗方案可明显提高肱骨髁上骨折的闭合复位成功率,降低手术率,避免和减少了并发症的发生,是一种理想的治疗手段。     

微创治疗儿童肱骨髁上不稳定骨折

目的 探讨以生物学固定及间接复位技术为基础,微创治疗儿童肱骨髁上不稳定骨折的临床疗效.方法 对86例儿童肱骨髁上不稳定骨折采用闭合复位,部分加内侧小切口,然后经皮克氏针交叉固定辅加石膏托外固定进行治疗.结果 术后随访时间为6个月至5年(平均2.5年),骨折全部愈合,平均愈合时间为1.2个月.参照Flum临床功能评定标准评定:优78例,良6例,可2例;优良率为98%.结论 以微创为原则闭合复位,经皮交叉克氏针内固定治疗儿童肱骨髁上不稳定骨折,该方法 符合生物学固定的观点,创伤小,并发症少,恢复快,疗效满意.     

自制偏心牵引带在桡骨远端骨折中的临床应用

目的：探讨自制手法复位工具应用于桡骨远端骨折的临床疗效。方法：自2011年2月至2012年6月,62例闭合性桡骨远端骨折,男26例,女36例;年龄6～83岁,平均48．5岁。其中Colles骨折59例,Smith骨折2例,Barton骨折1例。应用自制腕带-偏心牵引带手法复位后,结合小夹板及石膏外固定治疗。治疗后立即行X线检查评估疗效。结果：61例达到优良骨折复位标准,仅1例没有达到标准。62例患者获得随访,随访时间2～6个月,平均3．6个月,依据Dienst功能评估标准评价,优49例,良11例,可1例,差1例。结论：应用自制腕带-偏心牵引带为辅助工具手法复位桡骨远端骨折,骨折接近解剖对位,能显著提高手法复位成功率。     

Treatment of supracondylar fractures following prosthetic arthroplasty of the knee

Fifteen supracondylar fractures of the femur in patients with ipsilateral total knee arthroplasties were treated between 1975 and 1982. Three groups were identified for analyzation of treatment and end result. The average follow-up period after fracture was 18 months, with a range of ten to 48 months. Group I had four patients treated by closed reduction, cast immobilization, and early weight-bearing. At follow-up evaluation, three had a decrease in knee rating score, and one required a corrective osteotomy. Group II had eight patients treated by traction followed by cast or cast-brace immobilization. Four patients had a decrease in the knee rating because of malunion or loss of motion, and there was one nonunion requiring surgical treatment. Group III had three patients treated by immediate open reduction and internal fixation of the fracture. All three groups had functional arthroplasties following union of the fracture. Closed reduction and skeletal traction are recommended for the initial treatment. Open reduction and internal fixation, when technically feasible, is recommended when closed reduction and skeletal traction cannot maintain satisfactory alignment.