儿童肱骨髁上骨折的诊疗进展

肱骨髁上骨折是儿童肘部最常见的骨折.由于儿童肱骨远端特殊的解剖结构,使其不易获得稳定复位,增加了治疗的难度及术后并发症的发生率.根据骨折时受伤机制的不同,将儿童肱骨髁上骨折分为伸直型和屈曲型,绝大数患儿为伸直型;根据Gartland分型,又将其分为Gartland Ⅰ、Ⅱ、Ⅲ型.对于GartlandⅠ型儿童肱骨髁上骨折建议采用前臂中立位、屈肘90°长臂石膏固定3～4周;对于GartlandⅡ、Ⅲ型儿童肱骨髁上骨折闭合复位、经皮克氏针内固定仍是主要的治疗方法.近几年来,随着对肱骨髁上骨折研究的深入,对于穿针方式的选择出现越来越多的争议.也有部分学者报道了其他新兴的治疗方法,如弹性髓内针、单臂外固定架等,认为其术后不需要石膏固定,神经损伤发生率低,较传统克氏针内固定有一定优势.本文就目前儿童肱骨髁上骨折的分型方式、不同类型骨折治疗方式选择及其优缺点加以综述.

Recent advances in the diagnosis and treatment of supracondylar humeral fractures in children

Supracondylar humeral fractures are the most common around elbows in children.Due to special anatomical structure of distal humerus in children,obtaining stable reduction remains difficult and there is a high incidence of postoperative complications.According to the mechanism of injury,supracondylar humeral fractures are divided into extension and flexion types.According to the Gartland classification,supracondylar humeral fractures are divided into Gartland types Ⅰ,Ⅱ and Ⅲ.Gartland type Ⅰ supracondylar fractures of humerus are managed with 3-4 weeks of long-arm cast immobilization with elbow flexed to 90 and forearm held in neutral rotation.Closed reduction followed by stabilization of percutaneous Kirschner wire has been established as a standard treatment for types Ⅱ and Ⅲ supracondylar humeral fractures in children.In recent years,with an improved understanding of supracondylar humeral fractures,needle position appears more and more controversial.Some scholars also have proposed elastic intramedullary pin and external fixator.Postoperative plaster casting is not required and there is a lower incidence of nerve injury.This review summarizes the classification schemes of supracondylar humeral fractures,the therapeutic choices of different types of supracondylar humeral fractures and their merits and demerits.