摘要
目的:探讨GartlandⅢ型儿童肱骨髁上骨折屈肘位牵引摇摆复位手法的临床疗效。方法:2014年12月至2019年12月,本科采用屈肘位牵引摇摆复位手法复位、闭合穿针内固定治疗32例GartlandⅢ型儿童肱骨髁上骨折患者,疗效评定采用Flynn肘关节临床功能评分标准,随访观察治疗效果及不良反应。结果:本组手法复位时间(5±3)min。1次复位成功27例,2次复位成功5例,其中解剖复位28例,功能复位4例。术中透视(13±5)次,中位数9次。平均住院5 d(3~12 d),32例患者均获随访,最短6个月,最长18个月,中位数12个月。骨折均在术后3~5周获得临床愈合,拆除外固定和克氏针,指导循序渐进进行肘关节的主被动功能锻炼。疗效评定采用Flynn肘关节临床功能评分标准:术后3个月统计患肘关节总优良率为90.6%(29/32),术后6个月统计患肘关节总优良率为100%(32/32)。本组患者术后未出现医源性血管损伤、骨筋膜室综合征等严重不良并发症,未发生肘内翻。5例术前合并有神经、血管损伤患者均在3个月内得到良好恢复。结论:GartlandⅢ型儿童肱骨髁上骨折屈肘位牵引摇摆复位手法,符合逆损伤机制复位原理,一次复位成功率较高,复位效果好,综合疗效好,安全性高,且施术者较省力,值得临床推广应用。
Objective:To explore the clinical efficacy of Gartland type Ⅲ humeral supracondylar fracture in children treated by elbow flexion traction and swing reduction.Methods:Elbow flexion traction and swing reduction and closed pin internal fixation were used to treat 32 children with Gartland type Ⅲ humeral supracondylar fractures.The curative efficacy was evaluated by flynn elbow joint clinical function score standards.Efficacy of treatment and adverse reactions were recorded in the follow-up.Results:This group of manual reduction time was(5±3) min.27 cases were successfully restored at one time, and 5 cases were successfully restored at the second time, including 28 cases of anatomical reduction and 4 cases of functional reduction.Intraoperative fluoroscopy was performed(13±5) times, with a median of 9 times.The average hospital stay was 5 days(3 to 12 d).All 32 children were followed up 12 months(6 to 18 months).All fractures healed clinically 3 to 5 weeks after the operation.The external fixation and Kirschner wire were removed, and the active and passive functional exercises of the elbow joint were guided step by step for patients.The curative efficacy was evaluated by the flynn elbow joint clinical function scoring standard.The total excellent and good rate of the elbow joint was 90.6%(29/32) after 3 months, and the total excellent and good rate of the elbow joint was 100%(32/32) after 6 months.None of the children in this group had serious adverse complications such as iatrogenic vascular injury and compartment syndrome, and no elbow varus occurred.The 5 children with nerve and blood vessel injuries before the operation all recovered well within 3 months.Conclusion:The supracondylar fracture elbow flexion traction swing reduction technique is in line with the principle of inverse injury mechanism reduction to treat Gartland type Ⅲ pediatric humeral.It has a high success rate of one-time reduction, good reduction efficacy, good overall efficacy, high safety, and less effort for the operator, and is worthy of clinical application.
作者
梁勇
江平频
张新武
郭剑波
LIANG Yong;JIANG Pingpin;ZHANG Xinwu;GUO Jianbo(Xinyu Traditional Chinese Medicine Hospital,Xinyu 338025,Jiangxi China)
出处
《中国中医骨伤科杂志》
CAS
2021年第5期62-65,共4页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
关键词
肱骨髁上骨折
正骨手法
儿童
supracondylar fracture of humerus
fracture reduction technique
children
