儿童GartlandⅢ型肱骨髁上骨折内固定治疗及术后康复策略

摘要

目的 探讨儿童GartlandⅢ型肱骨髁上骨折(Supraondylar fracture of humerus,SFH)内固定治疗的方法与术后康复策略.方法 2009年1月至2011年11月在我院骨科闭合复位治疗失败后的GartlandⅢ型SFH患儿23例,采用小切口联合入路(肘外侧+内侧)交叉穿针或外侧穿入2～3根针固定,术后按软组织恢复期分阶段指导功能锻炼,经临床检查及X射线随访,统计肘内翻、骨化性肌炎及关节僵硬的发生情况,功能评价标准采用改良美国特种外科医院(HSS)肘关节功能评分系统.结果 1例患儿(就诊时间>9天)发生左前臂坏死转上级医院行截肢术,其余22例改良评分优12例、良6例、可2例、差2例,优良率为81.82%.23例全部获得随访,随访时间3～16个月,平均5.6个月.2例患儿出现神经损伤,1个月后均自行恢复;1例患儿遗留屈曲挛缩畸形,致伸肘在120°以内;3例患儿遗留肘内翻畸形,但肘关节功能良好;2例患儿发生骨化性肌炎.绪论儿童GartlandⅢ型SFH的治疗极具挑战性,伤后及时就诊及手术、术中精确复位与可靠固定、术后正确的指导功能锻炼常可获得良好预后;延迟手术、反复闭合复位及术后被动牵拉是影响患儿预后的重要因素,应注意避免.%Objective The purpose of this study was to analyze the outcomes of surgical treatment of Gartland type Ⅲ Supracondylar fracture of the humerus in children and sum up the experiences. Methods Between June 2009 and November 2011,23 cases of Gartland type III Supracondylar fracture of the humerus received operation after failed restoration practices conservative treatment. All of the patients were fixed by K-wires with mini-incision combined approach (lateral and medial) . Post surgical Rehabilitation Guidance used for the soft tissue recovery exercise. The patients were assessed both clinically and radiological, the results were tabulated according to HSS elbow performance index scores. Results Evaluations were completed for 22 cases. Operation time in the groups was 56 min, respectively. The mean follow-up time was 5. 6 months. According to the criteria of The HSS elbow performance index score, 12(55% ) elbows were rated excellent,6 (27% ) were rated good,2(9% )were rated fair,and 2(9% ) were rated poor. There was one case of vascular injury with delay treatment (9days after injury) have occurred vascular necrosis in the left forearm switch to a higher level hospital for amputation;2(9% )cases we found neurological injury,recovered without squealer in one month after operation. One case was left flexion contracture,the extension of elbow within 120°;3 cases was found cubitus varus,but the function of the elbow was good;2 cases was found myositis ossifications. Conclusion The Children Gartland Ⅲ supracondylar humeral fracture challenging, timely presentation and surgery, intraoperative precision reduction .reliable fixation and postoperative correct guiding functional exercise often obtain a good prognosis. Delayed surgery, repeated closed reduction and postoperative passive stretch are important factors affecting the children with prognosis.