儿童移位肱骨髁间骨折的手术治疗

目的：回顾性评估切开复位内固定术治疗儿童移位肱骨髁间骨折的临床效果。方法：自2007年3月至2009年2月，我科应用切开复位及内固定治疗了8例移位的肱骨髁间骨折患儿，其中男7例、女1例，平均年龄8．2岁（6-12岁）。按照Riseborough—Radin分型系统，其中III型6例、IV型2例；受伤机制包括：5例滑板车摔伤、1例摩托车摔伤、I例高处坠落伤、1例自行车摔伤。方法为采用Bryan～Morrey后内侧手术入路切开复位内固定术，应用克氏针钢丝或钉板系统内固定治疗。结果：术后无一例伤口感染及尺神经损伤，骨折均解剖对位。7例应用克氏针钢丝固定，1例行钉板系统固定。8例患儿均获得随访，平均随访时间2．2年（1．5～3年）。肘关节X线片显示无一例出现骨折的延迟愈合、不愈合，无一例肱骨远端骨骺坏死发生，2例合并肘关节异位骨化，肘关节屈伸活动度平均-10．6°-131．3°，日常生活无明显影响。结论：移位的肱骨髁间骨折患儿，应用Bryan—Morrey后内侧手术入路切开复位内固定术可获得较好的治疗效果。

Surgical Treatment for Displaced Intercondylar Fractures of the Humerus in Children

Objective： To retrospectively evaluate the clinical effect of open reduction and internal fixation for treating displaced intercondylar fractures of the humerus in chilreen. Methods： From March 2007 to February 2009, 8 children with displaced intercondylar fractures of the humerus, including 7 male and 1 female, with an average age of 8.2 years （ranging 6-12 years）, underwent open reduction and internal fixation by Bryan-Morrey triceps-sparing approach. Mechanisms of injury included scooter accidents in 5 cases, motor vehicle accidents in 1 case, fall from high in 1 ease and bicycling accidents in 1 case. Among them, there were 6 cases of type III and 2 cases of type IV as classified by Riseborough-Radin system. Results： All patieats were followed up for 1.5-3 years （2.2 years in average）, follow-up radiographs of elbow showed that there was no distal humeral epiphyseal necrosis, bone delayed-union or disunion noted except 2 patients had heterotopic ossification. The average range of elbow motion was -10.6°-131.3°. Conclusion： Open reduction and internal fixation through a Bryan-Morrey triceps-sparing approach can get a good effect for displaced intercondylar fractures of the humerus in children.