肘横纹切口手术治疗儿童 Gartland Ⅲ型肱骨髁上骨折35例

摘要

Objective To observe the curative effect of chelidon transverse incision in treating Gartland type Ⅲ humeral supracondylar fracture in children.Methods 35 cases of Gartland typeⅢ humeral supracon-dylar fracture in children by chelidon transverse incision from January 201 2 to September 201 3 were followed up,and the function of elbow joint was evaluated according to Flynn criteria. Results All patients healed by first intention (in 3 ~5 weeks,average of 3.6 weeks),One with cubitus varus,none with Volkmann ischemic contracture,myositis ossificans,incision scar contracture.The function of elbow joint was evaluated and had excellent results in 30 cases,good in 3 cases,not so good in 2 cases,bad in 0 case.Good rate was 94.3%. Conclusions Chelidon transverse incision is feasible in treating Gartland type Ⅲ humeral supracondylar frac-ture in children (extension type).It has the following advantages:simple approach,safe,small damage and easy to restore,slight scar,satisfactory effect,and convenient to explore nerve and vessels in operation.It is difficult to restore the fracture and maintain stable reduction in flexion type supracondylar humeral fracture in children,so this incision is not recommended in flexion type.%目的：探讨肘横纹切口手术治疗儿童 Gartland Ⅲ型肱骨髁上骨折的临床疗效及优缺点。方法2012年1月至2013年9月我们收治 Ganland Ⅲ型肱骨髁上骨折患儿35例，均采用肘横纹切口行内外髁交叉克氏针内固定治疗，参照 Flynn 标准对其肘关节功能进行随访和评价。结果35例随访时间3～24个月，平均10个月，术后切口均一期愈合，骨折愈合时间3～5周，平均3.6周。发生轻度肘内翻畸形1例，无一例出现 Volkmann 缺血性肌挛缩、骨化性肌炎，切口无瘢痕挛缩。肘关节功能评定：优30例，良3例，一般2例，差0例，优良率为94.3％。结论儿童 Ganland Ⅲ型肱骨髁上骨折（伸直型）选择肘横纹切口手术，方法简单，安全，损伤小，易于复位，愈合后瘢痕少，术中便于同时行神经血管探查，疗效满意。缺点是经此切口复位屈曲型骨折较困难，不易维持稳定复位，故屈曲型肱骨髁上骨折不建议采用此切口。