GartlandⅢ型儿童肱骨髁上骨折手术入路选择.doc

GartlandⅢ型儿童肱骨髁上骨折手术入路选择[摘要] 目的:总结GartlandⅢ型肱骨髁上骨折,分别应用肘关节后侧、外侧、内侧切口手术治疗的体会。方法:对46例GartlandⅢ型肱骨髁上骨折患儿,分别采用肘关节后侧、外侧、内侧切口,直视下复位骨折并用2枚克氏针固定,石膏固定4周。结果:46例患儿全部随访1年,根据Flynn标准,其中内侧和外侧小切口术后恢复良好率达94.1%,后侧正中切口良好率为50.0%。结论:肘内侧切口是手术治疗GartlandⅢ型儿童肱骨髁上骨折的首选切口。切口美观有利于准确复位,能够避免神经损伤,后期肘关节功能恢复好。 [关键词] 肱骨髁上;骨折;手术入路;石膏固定 [中图分类号] R683.41 [文献标识码]A [文章编号]1674-4721(2010)03(a)-036-02 Surgical approach of supracondylar humerous fracture of type Gartland Ⅲ in children WU Gang1,YANG Zilong1,HU Gang1,JI Shijun2 (1.Departments of Orthopedics, Chaoyang Central Hospital,Chaoyang 122000, China;2. Department of Pediatric Orthopedics,Shengjing Hospital of China Medical University, Shenyang 110000, China) [Abstract] Objective: To compare the outcomes of the posterior,lateral and medial surgical approaches in the treatment of supracondylar humerous fracture of type Gartland Ⅲ in children. Methods: 46 patients of type Gartland Ⅲ supracondylar humerous fracture were treated through the posterior,lateral and medial surgical approaches. Open reduction and Kirschwire fixation were executed followed by 4 weeks cast fixation. Results: All the patients were followed-up for at least 1 year.According to Flynn outcome classification,those treated through lateral and medial surgical approaches had a satisfactory result in 94.1% of the patients, while the posterior approach only got 50.0% satisfaction. Conclusion: The medial surgical approach is the first option in treating supracondylar humerous fracture of type Gartland Ⅲ in children. It facilitates good reduction, avoids neurological complication and also offers good elbow function with less cosmetic problem. [Key words] Supracondylar humerous;Fracture;Surgical approaches;Cast fixation 随着目前儿童娱乐项目的增多,儿童骨折开始多发,肘部骨折占所有儿童骨折的30%,其中肱骨髁上骨折占50%～70%[1]。如不能及时治疗或处理不当,易出现Volkmann挛缩、关节功能障碍及肘部畸形等并发症。Gartland[2]将肱骨髁上骨折分为3型,Ⅰ型:骨折无移位。Ⅱ型:骨折轻度移位,骨皮质相连。Ⅲ型:骨折明显移位,骨折断端完全分离无接触。GartlandⅢ型肱骨髁上骨折是一种较难以手法复位、不稳定的骨折,且有时伴有血管神经损伤,手术切开复位成为骨科医生的共识[3]。本院2006年1月～2008年12月,共