GartlandⅢ型儿童肱骨髁上骨折的微创治疗

目的探讨Gartland Ⅲ型儿童肱骨髁上骨折微创治疗的手术技巧及疗效。方法回顾性分析2011年7月~2013年9月我们
收治的62例Gartland Ⅲ型儿童伸直型肱骨髁上骨折患者的临床病历资料，其中伸直尺偏型42例，伸直桡偏型20例，男43例，女
19例，年龄1岁8月~13岁2月，平均6岁3月。高处坠落伤14例，运动中摔伤48例。受伤至手术时间为6~48 h，平均13.5 h。均
可采用单人操作完成闭合复位、经皮克氏针内固定术，术后管型石膏外固定。术后3、6、12、24个月时采用Flynn肘关节评分标
准评定疗效。结果手术时间26.8±15.6 min；术中透视次数9.2±2.6次。所有患者术后均获随访，平均随访时间16.5个月（6~30
个月），术后3~4周均获骨折临床愈合，拆除管型石膏及克氏针，开始指导主动及被动功能锻炼。按照Flynn肘关节临床功能评
分标准评定疗效：术后3个月优良率为85%（53/62），术后6个月优良率为100%（62/62）。术后患儿均未出现骨筋膜室综合征、血
管损伤等并发症；3例患儿术后出现一过性尺神经损伤症状，术后3个月均逐渐恢复。结论闭合复位克氏针内固定的微创方法
治疗Gartland Ⅲ型儿童肱骨髁上骨折疗效确切。该方法操作相对简单，手术时间短，对患儿创伤小，术后并发症少，有利于肘关
节功能早期恢复，值得推广。

Minimally invasive treatment of gartland type III humerus supracondylar fracture inchildren

Objective To explore minimally invasive surgical techniques for Gartland type III humeral supracondylar fracture in
children and evaluate the outcomes of the patients. Methods We retrospectively analyzed 62 children (43 boys and 19 girls,
aged 1 year and 8 months to 13 years and 2 months, mean 6 years and 3 months) with Gartland type III humeral supracondylar
fracture treated in our department from July, 2011 to September, 2013, including 42 with extension-ulnar type humeral
supracondylar fracture and 20 with deviation-ulnar type. The injury to operation time ranged from 6 to 48 h with a mean of
13.5 h. Close reduction and percutaneous pinning internal fixation was performed by a single surgeon in all cases with plaster
cast fixation for 3 to 4 weeks. The patients were followed up regularly and Flynn elbow scoring criteria was used to evaluate
the outcomes. Results The mean operation time was 26.8±15.6 min with a mean intraoperative fluoroscopy frequency of 9.2±
2.6 and a mean follow-up for 16.5 months (6 to 30 months). Clinical healing was achieved in 3 to 4 weeks without fracture
displacement after removal of the internal fixation, and active and passive functional exercise was initiated. According to the
Flynn elbow scoring criteria, excellent outcome was achieved in 53 (85%) cases at 3 months in 62 (100%) cases at 6 months after
the surgery. No such complications as osteofascial compartment syndrome or vascular injuries occurred in these patients.
Three children had alnar nerve injury symptoms after the operation but all recovered in 3 months. Conclusion The minimally
invasive method with closed reduction and percutaneous pinning internal fixation is feasible for treatment of Gartland type III
humerus condyle fracture in children. This approach involves relatively simple operation with shorter operation time, minimal
trauma, and less complications after operation, and promotes early functional recovery of the elbow joint.