Treatment of“High”supracondylar humerus fractures in children using closed reduction and percutaneous kirschner wire fixation
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摘要: 目的 介绍采用手法闭合复位加经皮穿克氏钉治疗儿童肱骨高位髁上骨折的方法及治疗体会。 方法 选择2013年1月—2015年7月安徽省儿童医院骨科治疗的32例儿童肱骨高位髁上骨折患儿,均采用手法闭合复位后加直接经皮肤穿交叉克氏钉治疗,术后予以肘关节石膏托外固定4周,4周后复查摄片见骨折愈合后拆除石膏,拔钉后配合功能锻炼。 结果 32例患儿分别于术后1、3、6、12个月获得随访,随访期最短3个月,最长12个月。根据术后肘关节功能恢复情况,采用Flynn肘关节评分标准:32例患儿术后经过3~12个月的随访,优26例,良5例,可1例。所有治疗均取得满意的治疗效果。患儿肘关节活动功能最短在术后1.5个月,最长在术后3个月恢复正常。32例患儿中无一例出现骨折再移位,无肘关节活动功能受限,无一例发生尺神经损伤,未出现钉尾激惹感染病例。 结论 闭合复位加经皮穿克氏钉可有效治疗儿童肱骨高位髁上骨折,避免传统切开复位方法所引起的手术创伤及术后疤痕的形成,可获得良好的肘关节功能。利用手法闭合复位加经皮穿克氏钉技术治疗儿童肱骨高位髁上骨折可以维持较强的骨折复位后的稳定性,手术操作简单、安全、创伤小、远期无疤痕,而且并发症少,非常值得在临床推广应用。Abstract: Objective To evaluate the efficacy of closed reduction and percutaneous Kirschner wire fixation in the treatment of "High" supracondylar humerus fractures in children. Methods The closed reduction and percutaneous Kirschner wire fixation were performed in 32 children with upper supracondylar humerus fractures in our hospital between January,2013 and July,2015 After 4 weeks of plaster external fixation,the radiography was performed to confirm the condition of fractures,and the internal and external fixation were removed and functional exercise was carried out when the fractures were healed. Results All patients were followed up for 3 to 12 months.Flynn clinical functional assessment standards showed the excellent in 26 cases,good in 5 cases and general in 1 case.All cases achieved satisfactory results.Elbow movement function recovered in the shortest period of 1.5 months after the surgery,the longest period of 3 months after the surgery.There was no case with fractures displacement,functional limitations,ulnar nerve injury,and irritation of the surrounding soft tissues. Conclusion Closed reduction and percutaneous Kirschner wire fixation is effective for the supracondylar humerus fractures in children,which can avoid the surgical trauma and postoperative scar caused by open reduction,obtain strong stability and obtain a good elbow function.The operation is simple and safe with small trauma and fewer complications.It is worthy promotion in clinical application.
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