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目的探讨切开复位克氏针固定治疗肱骨髁上骨折患儿的疗效。方法回顾性分析2009年9月至2015年12月于本院接受切开复位手术治疗的31例儿童肱骨髁上骨折的临床资料,其中男18例,女13例,年龄11个月~14岁,平均4.5岁。受伤至手术间隔时间为10 h~13天,平均1.8天。均采用肱骨远端外侧入路切开复位,直视下克氏针内固定术,术后支具功能位外固定。术后3、6、12、18、24、30个月时采用Flynn肘关节评分标准评定疗效。结果本组均获得随访,资料完整,随访12~30个月,平均24.6个月。闭合复位失败者23例;开放骨折者4例;合并神经损伤者4例。本组病例平均手术时间为38.2(30~48)min,术中出血平均20.8(15~40)ml,平均住院日6.2(4~15)天。按照Flynn肘关节临床功能评分标准评定疗效:术后3个月优良率为74.2%(23/31),术后12个月优良率为96.8%(30/31),其中1例肘关节屈伸活动度减少>15°。术后患儿均未出现伤口不愈合、骨筋膜室综合征、血管损伤、神经损伤、骨折不愈合、肘关节内、外翻畸形等并发症。结论外侧小切口切开复位治疗儿童肱骨髁上骨折疗效确切。该方法操作相对简单,手术风险小、时间短,对患儿创伤小,并发症少,可以有效治疗上述类型的肱骨髁上骨折。
Objective To investigate the curative effect of open reduction and Kirschner wire fixation in children with supracondylar fracture of humerus. Methods The clinical data of 31 cases of supracondylar humerus fractures treated in our hospital from September 2009 to December 2015 were retrospectively analyzed. There were 18 males and 13 females, ranging in age from 11 months to 14 years , An average of 4.5 years old. Injuries to surgery interval of 10 h ~ 13 days, an average of 1.8 days. The distal humerus lateral approach was used to open reduction, under direct vision Kirschner wire fixation, postoperative functional fixation outside the bit. At 3, 6, 12, 18, 24 and 30 months after operation, the Flynn elbow score was used to evaluate the curative effect. Results The group were followed up, the data is complete, followed up for 12 to 30 months, an average of 24.6 months. Closed reduction failure in 23 cases; open fractures in 4 cases; 4 cases of nerve injury. The average operation time was 38.2 (30 ~ 48) min in patients with intraoperative bleeding average 20.8 (15 ~ 40) ml, the average length of stay 6.2 (4 ~ 15) days. The curative effect was evaluated according to the Flynn elbow clinical score: 74.2% (23/31) at 3 months and 96.8% (30/31) at 12 months postoperatively. One case of elbow flexion and extension activities Degree reduction> 15 °. No postoperative wound healing, osteofascial compartment syndrome, vascular injury, nerve injury, fracture nonunion, elbow joint, valgus deformity and other complications. Conclusion Small lateral incision and reduction in the treatment of supracondylar fracture of humerus is effective. The method has the advantages of relatively simple operation, small operation risk, short time, less trauma to the children and less complications, and can effectively treat the supracondylar fractures of the humerus.