摘要
目的 分析受伤的机制及病理解剖的类型,评价闭合复位经皮克氏针内固定治疗儿童漂浮肘的疗效。方法 对1996年到2001年间的13例儿童漂浮肘进行回顾性研究。其中,男8例,女5例。平均年龄7岁。桡骨骨折13例,尺桡骨双骨折10例。桡骨骨折中9例为骨折断端完全分离,2例为Salter-HarrisⅡ型骨折,2例为青枝骨折。肱骨髁上骨折中8例为GartlanⅢ型,4例为Ⅰ型,1例为Ⅱ型。1例患儿有正中神经损伤。对Ⅱ、Ⅲ型的肱骨髁上骨折和移位的桡骨远程骨折,在直视下行手法复位和经皮克氏针内固定。术中术后密切观察血循环。结果 按修订Flynn表对疗效作客观的评价。11例患儿前臂旋转和肘关节的功能正常,1例患儿有11°关节欠屈,8°前臂旋转受限。1例患儿有20°关节欠屈,15°前臂旋转受限。正中神经损伤的患儿,4个月后完全恢复正常。无肘内外翻畸形,无感染。本组患儿普遍有关节囊松弛。结论 在良好的麻醉下,行手法复位经皮克氏针治疗飘浮肘是一种有效的方法。
Objective To define the mechanism, pathological anatomy of injury and explore the ef-
ficacy and safety of closed reduction and percutaneous K-wires fixation to treat 'floating elbow' in children.
Methods From 1996 to 2001, 13 cases (8 boys and 5 girls) of 'floating elbow' with average age of 7
years (3～10 years) were admitted. Both the radius and ulna were fractured in 10 cases and simple radius
was fractured in 3. The radius fracture types included 2 cases with Salter-Harris Ⅱ, 9 cases with complete
displacement of fracture and 2 with greenstick fracture. Eight patients with supracondylar fracture of the
humerus belonged to Gartland type Ⅲ, 1 case to type Ⅱ and 4 cases to type Ⅰ. The cases with Gartland Ⅲ
fractures were associated with complete displacement of the radius fractures. In addition, three cases with
postero-lateral displacement of supracondylar fracture showed dorsal-ulnar displacement of radius fracture.
Six cases of postero-medial displacement of supracondylar fracture presented with dorsal-radial displacement
of radius. One case had median nerve injury at the time of admission. All were treated with primary closed
reduction and percutaneous Kirschner wire pinning. The techniques were to reduce and pin the forearm
fracture first, and circulation was closely monitored intra- and post-operatively. Manipulation was done gen-
tly to avoid further injuries to the neurovascular bundle. Patients were followed-up for an average of 39.2
months and analysed in detail clinically and radiologically. Results According to the modified Flynn criteri-
a, one had 11° deficiency of the range of elbow motion and 8° deficiency of forearm supination, the worst
case had 20° limitation of elbow flexion and 15° limitation of forearm supination and the remaining 11 cases
had satisfactory elbow and forearm movements. The median nerve palsy in one case was completely recov-
ered after 4 months. No residual varus and valgus were found in all cases except ligament hyperlaxity. Ra-
diologically displacement of the supracondylar fracture of humerus was closely associated with displacement
of the fracture at the radius pointing to the similar pathoanatomy and mechanism of injury. Conclusion
Closed reduction and percutaneous Kirschner wire fixation are convenient and effective operations on floating
elbow in children.
出处
《中华小儿外科杂志》
CSCD
北大核心
2003年第5期439-442,共4页
Chinese Journal of Pediatric Surgery
关键词
经皮克氏针内固定
治疗
儿童
漂浮肘
Orthopedic procedures
Fracture fixation, internal
Elbow
