前侧入路手术治疗儿童肱骨髁上骨折.doc

前侧入路手术治疗儿童肱骨髁上骨折 孙 客1，唐盛平1，徐江龙1，于薇2，刘丹1 （深圳市儿童医院 1.骨科；2.超声科，深圳 518026） [摘要] 目的　探讨前侧入路手术治疗儿童肱骨髁上骨折的适应症、优点及其并发症的处理。方法　本组32例，男25例，女7例，平均4.6岁，受伤原因均为跌伤，其中4例在外院手法复位未成功后转来我院。其中开放型骨折4例，闭合型28例；伸直型27例（均为GartlandⅢ型），屈曲型5例；伴有尺偏型15例，桡偏型9例，合并旋转者8例。入院时合并桡神经损伤3例，正中神经损伤6例，尺神经损伤1例，骨筋膜室综合症早期表现者6例。开放型骨折及肱动脉受压表现患儿均在麻醉下行清创、急诊开放手术；其余患儿行皮肤牵引或尺骨鹰嘴过头位骨牵引治疗，4~7天后（平均5天）手术治疗；根据患儿具体病情选择前外侧、前正中或前内侧入路手术（即受伤严重侧、或神经血管损伤侧），进行探查并复位骨折后，从肱骨小头处自外向内上打入两枚交叉克氏针固定骨折断端。结果　27例获得1.5年的随诊，未发生Volkmann缺血性孪缩病例；1例发生针道感染经抗炎、局部切开引流、换药治疗后痊愈。根据Flynn[1]标准评定：所有患儿提携角正常或基本正常，均未发现肘内、外翻畸形；肘关节屈伸功能优25例，良2例。入院时存在神经、血管损伤者，除1例尺神经损伤不恢复，于术后4月再次行尺神经前置术外，均在出院后3月内恢复。结论　对于有血管神经并发症、开放型以及错位严重而致复位困难的儿童肱骨髁上骨折，切开复位是确实有效的治疗手段，而前侧入路手术由于对伤情暴露充分，处理方便及手术副损伤少等优点，值得推荐。 [关键词] 儿童; 肱骨髁上骨折; 前侧入路手术 Treatment of humeral supracondylar fractures in children via anterior approach surgeries. SUN Ke, TANG Sheng-ping ,Xu Jiang-long ,et al. Department of Pediatric Surgery, Shenzhen Children’ Hospital, Shenzhen, 518026,China. [Abstract] Objective To investigate into the indications, advantages as well as the manipulation of complications in treatment of humeral supracondylar fractures in children via anterior approach surgeries. Method The study was carried out on 32 cases including 25 males and seven females with an average age of 4.6. All the cases suffered from falling injuries and four of them were transferred to our hospital after failures of manipulative reductions in other hospitals. By different classification standards, the sufferings included four open fractures and 28 closed fractures; 27 extension-type fractures (all of GartlandⅢ type) and five flexion-type fractures; 15 with ulnar deviation, nine with radial deviation and eight with rotation. On admission, three cases suffered from associated injuries of radial nerves, six from median nerves and one from ulnar nerves; six patients had early-stage manifestations of osteofascial compartment syndrome. Debridement and emergent open surgeries under anesthesia were conducted on children with open fracture