手法整复屈肘90°纸夹板外固定治疗Ⅰ型肱骨小头骨折

目的：探讨手法整复Ⅰ型肱骨小头骨折的动作要点及纸夹板体系固定特点。方法：自2000年4月至2008年2月手法治疗Ⅰ型肱骨小头骨折27例,男23例,女4例;年龄5～14岁,平均8.9岁;病程1～23h,平均5.4h。术前患肘均肿胀、功能障碍。X线片示肱骨小头骨折块不同程度分离、翻转移位。整复时找到正确的复位着力点,整复动作准确、连贯、稳定并配合前臂及肘关节的被动动作,屈肘90°以纸夹板体系固定。所有患者以JOA肘关节功能评价法进行功能评分。结果：27例均获随访,时间6个月～2年,平均17个月。肘关节均无痛,活动度、功能均正常,肘关节均无动摇性。整复后未出现并发症。25例断端达到或接近解剖对位愈合,2例出现轻度肘外翻畸形。JOA评分100分25例,97分2例。结论：手法整复屈肘90°纸夹板外固定治疗Ⅰ型肱骨小头骨折稳定性强、成功率高、固定牢固、轻便且不会出现组织压疮及坏死。

Manual reduction of 90 degree bending elbow and external fixation with paper splint for treatment of type I capitellum fractures

Objective: To study the operation points of manual reduction for treatment of capitellum fractures of type I and analyze the characteristics of fixation with paper splint. Methods: From April 2000 to February 2008,27 cases with capitellum fractures of type I were treated by manual reduction of 90° bending elbow and external fixation with paper splint,included 23 males and 4 females aged from 5 to 14 years old (means 8.9 years) with the course from 1 to 23 hours (averaged 5.4 hours). Before treatment all the wounded elbows were swollen and malfunctioned,the X-ray film showed that the fracture fragments of capitellum were separated and upside down displaced in varying degrees. During reduction,the correct restoration point was found and the reduction was correct,continuous and steady,and coordinated the passive movement of forearm and elbow joint,and the 90° bending elbow was fixed by paper splint. All the patients were assessed according to JOA elbow joint function assessment method. Results: All 27 patients were followed-up for from 6 months to 2 years (averaged 17 months). All the elbow joints were painless,the movement and functions were normal,the elbow joints were stable. After reduction,no complication was found. There were 25 cases with the fracture site reaches or nearly reaches healing of anatomical counterparts,only 2 cases with slight cubitus valgus deformity. According to JOA score 25 cases gained 100 scores and 2 cases gained 97 scores. Conclusion: This method has advantage of strong stability,high success rate,firm and easy fixation,without pressure sore and necrosis.