儿童肱骨髁上骨折复位判断指标系统在克氏针内固定术中的综合应用
胡健;李洪鹏;吴冰;孙培峰;徐朋;陈君;曲良;冯承臣;宋展昭;
摘要(Abstract)：
[目的]探讨闭合或切开复位克氏针内固定治疗儿童肱骨髁上骨折手术中骨折复位判断指标系统的应用及效果。[方法]建立儿童肱骨髁上骨折复位判断指标系统,包括Baumann角(B角)、肱骨小头前倾角、肱骨皮质前线、骨折端间隙;在C型臂X线机透视下,闭合或切开复位骨折,测量并纠正患侧Baumann角(B角)、肱骨小头前倾角、肱骨皮质前线、骨折端间隙,以达到骨折解剖复位,避免远折端内倾。克氏针固定治疗儿童肱骨髁上骨折85例。其中男48例,女37例;年龄(3.5~12.5)岁,平均6.3岁,伸直尺偏型50例,伸直桡偏型32例,屈曲型3例。[结果]平均随访时间18.5个月。最后一次随访测患侧B角为(73.8±5.6)°,健侧为(72.8±5.9)°;提携角(C角)患侧平均(8.2±5.2)°,健侧平均(10.2±5.7)°。9例C角减少(5~10°),其中3例发生轻度肘内翻。无1例C角减少超过10°,无肘外翻畸形,未出现Volkmann挛缩及尺神经的医源性损伤。根据Flynn评价优良率为97.8%。[结论]应用肱骨髁上骨折复位判断指标系统,可完全纠正骨折的各向移位及骨折远端的尺侧移位和内倾,结合克氏针内固定,可避免骨折畸形愈合,恢复良好的肘关节功能。
关键词(KeyWords)： 肱骨髁上骨折;肘;畸形;骨折固定术
基金项目(Foundation):
作者(Author): 胡健;李洪鹏;吴冰;孙培峰;徐朋;陈君;曲良;冯承臣;宋展昭;
Email:
DOI:
参考文献(References)：
- [1]徐华梓,李也白,池永龙,等.儿童严重型肱骨髁上骨折手术治疗远期疗效分析[J].中华创伤杂志,1993,9:346.
- [2]Lee BJ,Lee SR,Kim ST,et al.Radiographic outcomes after treatment of pediatric supracondylar humerus fractures using a treatmentbased classification[J].J Orthop Trauma,2011,25(1):18-25.
- [3]Flynn JC,Matthews JG,Benoit RL.Blind pinning of displaced supracondylar fractures of the humerus in children:sixteen years'experience with long-term follow-up[J].J Bone Joint Surg Am,1974,56(2):263-272.
- [4]Griffet J,Abou Daher A,Breaud J,et al.Systematic percutaneous pinning of displaced extension-type supracondylar fractures of the humerus in children:a prospective study of 67 patients[J].Eur J Orthop Surg Traumatol,2004,14(4):214.
- [5]徐华梓,池永龙,毛方敏,等.Baumann角测量的意义及其影响因素[J].中华小儿外科杂志,1997,26(5):295-297.
- [6]Kocher MS,Kasser JR,Waters PM,et al.Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children[J].J Bone Joint Surg Am,2007,89(4):706-712.
- [7]申素芳,张志桐,陈妹红,等.肱骨远端骨骺前倾角度-外髁骺干角的超声测量[J].中华超声影像学杂志,2004,13(3):205-207.
- [8]Simanovsky N,Lamdan R,Hiller N,et al.The measurements and standardization of humerocondylar angle in children[J].J Pediatr Orthop,2008,28(4):463-465.
- [9]黄淑明,赵晓君,水小龙,等.儿童侧位肱骺角的测量及其临床意义[J].中华骨科杂志,2009,29(11):1048-1051.
- [10]Camus T,Mac Lellan B,Cook PC,et al.Extension typeⅡpediatric supracondylar humerus fractures:a radiographic outcomes study of closed reduction and cast immobilization[J].J Pediatr Orthop,2011,31(4):366-371.
- [11]Beck JD,Riehl JT,Moore BE,et al.Risk factors for failed closed reduction of pediatric supracondylar humerus fractures[J].J Orthop Am,2012,35(10):1492-1496.