小切口穿针术在儿童Gartland Ⅲ型肱骨髁上骨折的应用
|
摘要
目的探讨小切口穿针术治疗儿童Gartland Ⅲ型肱骨髁上骨折的手术方式和治疗效果。方法 2002年9月-2009年7月,收治189例儿童Gartland Ⅲ型肱骨髁上骨折。男137例,女52例;年龄1～13岁,平均6.2岁。运动伤173例,车祸伤9例,高处坠落伤5例,地震伤2例。伴其他部位骨折11例;桡神经损伤36例,正中神经损伤5例,尺神经损伤2例;肱动脉断裂2例。受伤至入院时间1h～10d。采用小切口穿针术治疗骨折,同期行神经、血管探查修复。结果术后切口均Ⅰ期愈合,无相关并发症发生。143例获随访,随访时间5个月～5年,平均12个月。X线片示骨折均愈合,愈合时间2～4个月,平均2.5个月。6例发生肘内翻,但肘关节屈伸功能基本正常;其中2例行肱骨远端楔形截骨矫形术,余继续功能锻炼。肘关节功能评价参照Flynn等临床功能评定标准:优121例,良15例,可7例,优良率95.1%。术后切口未遗留明显瘢痕,神经、血管损伤者术后功能均基本恢复正常。结论小切口穿针术治疗儿童Gartland Ⅲ型肱骨髁上骨折具有创伤小、手术时间短、操作简便、手术并发症少的优点。
Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type Ⅲ humeral supracondylar fracture in children.Methods From September 2002 to July 2009,189 patients with Gartland type Ⅲ humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning.There were 137 males and 52 females,aged from 1 to 13 years(6.2 years on average).Injury was caused by sports in 173 cases,by traffic accident in 9 cases,by falling from height in 5 cases,and by earthquake in 2 cases.All fractures were closed fractures,complicating others fracture in 11 cases,radial nerve injury in 36 cases,median nerve injury in 5 cases,ulnar nerve injury in 2 cases,and brachial artery injury in 2 cases.The time from injury to hospitalization was 1 hour to 10 days.Neurovascular repair was performed at the same period.Results All incisions healed by first intention,no related complications occurred.A total of 143 patients were followed up 5 months to 5 years(12 months on average).X-ray films showed fracture healed within 2-4 months(2.5 months on average).Cubitus varus occurred in 6 cases,but the functions of elbow flexion and extension were good;2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training.According to the Flynn et al criteria,the results were excellent in 121 cases,good in 15 cases,and fair in 7 cases;the excellent and good rate was 95.1%.Only a small incision scar was found,the function returned to normal in the cases complicated by nerve and blood vessel injury.Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type Ⅲ humeral supracondylar fracture in children is a safe and effective surgical procedure,which has minimal trauma,short surgery time,quick recovery,simple operation,and can be effective in reducing the complications.
Objective To investigate the operative procedure and the therapeutic effects of minimally invasive incision and percutaneous pinning in operative treatment of Gartland type Ⅲ humeral supracondylar fracture in children.Methods From September 2002 to July 2009,189 patients with Gartland type Ⅲ humeral supracondylar fracture were treated with minimally invasive incision and percutaneous pinning.There were 137 males and 52 females,aged from 1 to 13 years(6.2 years on average).Injury was caused by sports in 173 cases,by traffic accident in 9 cases,by falling from height in 5 cases,and by earthquake in 2 cases.All fractures were closed fractures,complicating others fracture in 11 cases,radial nerve injury in 36 cases,median nerve injury in 5 cases,ulnar nerve injury in 2 cases,and brachial artery injury in 2 cases.The time from injury to hospitalization was 1 hour to 10 days.Neurovascular repair was performed at the same period.Results All incisions healed by first intention,no related complications occurred.A total of 143 patients were followed up 5 months to 5 years(12 months on average).X-ray films showed fracture healed within 2-4 months(2.5 months on average).Cubitus varus occurred in 6 cases,but the functions of elbow flexion and extension were good;2 cases were given distal humeral wedge osteotomy and 4 cases continued keeping the functional training.According to the Flynn et al criteria,the results were excellent in 121 cases,good in 15 cases,and fair in 7 cases;the excellent and good rate was 95.1%.Only a small incision scar was found,the function returned to normal in the cases complicated by nerve and blood vessel injury.Conclusion Minimally invasive incision and percutaneous pinning for operative treatment of Gartland type Ⅲ humeral supracondylar fracture in children is a safe and effective surgical procedure,which has minimal trauma,short surgery time,quick recovery,simple operation,and can be effective in reducing the complications.
引文
1潘少川.实用小儿外科学.2版.北京:人民卫生出版社,2005:443-450.
2Gartland JJ.Management of supracondylar fractures of the humerus in children.Surg Gynecol Obstet,1959,109(2):145-154.
3Kasser JR.Percutaneous pinning of supracondylar fractures of the hu-merus.Instr Cours Lect,1992,41:385-390.
4Omid R,Choi PD,Skaggs DL.Supracondylar humeral fractures in children.J Bone Joint Surg(Am),2008,90(5):1121-1132.
5黄淑明,孙建中,水小龙,等.闭合复位经皮内固定治疗肱骨髁上骨折的进展.中国矫形外科杂志,2009,17(16):1234-1237.
6曹豫江,李明,张德文,等.切开复位克氏针固定治疗儿童严重型肱骨髁上骨折181例报道.重庆医学,2007,36(9):793-794,796.
7Flynn JC,Matthews JG,Benoit RL.Blind pinning of displaced supra-condylar fractures of the humerus in children.Sixteen years’experience with long-term follow-up.J Bone Joint Surg(Am),1974,56(2):263-272.
8Kaiser MM,Kamphaus A,Massalme E,et al.Percutaneous closed pin fi xation of supracondylar fractures of the distal humerus in children.Oper Orthop Traumatol,2008,20(4-5):297-309.
9Parmaksizoglu AS,Ozkaya U,Bilgili F,et al.Closed reduction of the pediatric supracondylar humerus fractures:the“joystick”method.Arch Orthop Trauma Surg,2009,129(9):1225-1231.
10Mubarak SJ,Carroll NC.Volkmann’s contracture in children:aetiol-ogy and prevention.J Bone Joint Surg(Br),1979,61-B(3):285-293.
11Kalenderer O,Reisoglu A,Surer L,et al.How should one treat iatrogen-ic ulnar injury after closed reduction and percutaneous pinning of pae-diatric supracondylar humeral fractures.Injury,2008,39(4):463-466.
12Mehlman CT,Crawford AH,McMillion TL,et al.Operative treatment of supracondylar fractures of the humerus in children:the Cincinnati experience.Acta Orthop Belg,1996,62Suppl1:41-50.
13Oh CW,Park BC,Kim PT,et al.Completely displaced supracondylar humerus fractures in children:results of open reduction versus closed reduction.J Orthop Sci,2003,8(2):137-141.
14廖前德,黄建军,李人杰,等.严重型儿童肱骨髁上骨折132例临床分析.中国全科医学,2010,13(1B):193-194.
15李丽君.C型臂X线机透视下手术X线辐射的防护体会.江西医药,2008,43(11):1256-1257.
16Reitman RD,Waters P,Millis M.Open reduction and internal fi xation for supracondylar humerus fractures in children.J Pediatr Orthop,2001,21(2):157-161.
17张志群,楼跃,夏榕圻,等.肘内侧入路手术治疗儿童GartlandⅢ型肱骨髁上骨折.南京医科大学学报:自然科学版,2009,29(12):1727-1729.
18Houshian S,Mehdi B,Larsen MS.The epidemiology of elbow fracture in children:analysis of355fractures,with special reference to supra-condylar humerus fractures.J Orthop Sci,2001,6(4):312-315.
19Yen YM,Kocher MS.Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children.Surgical technique.J Bone Joint Surg(Am),2008,90Suppl2Pt1:20-30.
20Lee YH,Lee SK,Kim BS.Three lateral divergent or parallel pin fi xa-tions for the treatment of displaced supracondylar humerus fractures in children.J Pediatr Orthop,2008,28(4):417-422.
21Larson L,Firoozbakhsh K,Passarelli R,et al.Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures.J Pediatr Orthop,2006,26(5):573-578.
22Zamzam MM,Bakarman KA.Treatment of displaced supracondylar humeral fractures among children:crossed versus lateral pinning.In-jury,2009,40(6):625-630.
2Gartland JJ.Management of supracondylar fractures of the humerus in children.Surg Gynecol Obstet,1959,109(2):145-154.
3Kasser JR.Percutaneous pinning of supracondylar fractures of the hu-merus.Instr Cours Lect,1992,41:385-390.
4Omid R,Choi PD,Skaggs DL.Supracondylar humeral fractures in children.J Bone Joint Surg(Am),2008,90(5):1121-1132.
5黄淑明,孙建中,水小龙,等.闭合复位经皮内固定治疗肱骨髁上骨折的进展.中国矫形外科杂志,2009,17(16):1234-1237.
6曹豫江,李明,张德文,等.切开复位克氏针固定治疗儿童严重型肱骨髁上骨折181例报道.重庆医学,2007,36(9):793-794,796.
7Flynn JC,Matthews JG,Benoit RL.Blind pinning of displaced supra-condylar fractures of the humerus in children.Sixteen years’experience with long-term follow-up.J Bone Joint Surg(Am),1974,56(2):263-272.
8Kaiser MM,Kamphaus A,Massalme E,et al.Percutaneous closed pin fi xation of supracondylar fractures of the distal humerus in children.Oper Orthop Traumatol,2008,20(4-5):297-309.
9Parmaksizoglu AS,Ozkaya U,Bilgili F,et al.Closed reduction of the pediatric supracondylar humerus fractures:the“joystick”method.Arch Orthop Trauma Surg,2009,129(9):1225-1231.
10Mubarak SJ,Carroll NC.Volkmann’s contracture in children:aetiol-ogy and prevention.J Bone Joint Surg(Br),1979,61-B(3):285-293.
11Kalenderer O,Reisoglu A,Surer L,et al.How should one treat iatrogen-ic ulnar injury after closed reduction and percutaneous pinning of pae-diatric supracondylar humeral fractures.Injury,2008,39(4):463-466.
12Mehlman CT,Crawford AH,McMillion TL,et al.Operative treatment of supracondylar fractures of the humerus in children:the Cincinnati experience.Acta Orthop Belg,1996,62Suppl1:41-50.
13Oh CW,Park BC,Kim PT,et al.Completely displaced supracondylar humerus fractures in children:results of open reduction versus closed reduction.J Orthop Sci,2003,8(2):137-141.
14廖前德,黄建军,李人杰,等.严重型儿童肱骨髁上骨折132例临床分析.中国全科医学,2010,13(1B):193-194.
15李丽君.C型臂X线机透视下手术X线辐射的防护体会.江西医药,2008,43(11):1256-1257.
16Reitman RD,Waters P,Millis M.Open reduction and internal fi xation for supracondylar humerus fractures in children.J Pediatr Orthop,2001,21(2):157-161.
17张志群,楼跃,夏榕圻,等.肘内侧入路手术治疗儿童GartlandⅢ型肱骨髁上骨折.南京医科大学学报:自然科学版,2009,29(12):1727-1729.
18Houshian S,Mehdi B,Larsen MS.The epidemiology of elbow fracture in children:analysis of355fractures,with special reference to supra-condylar humerus fractures.J Orthop Sci,2001,6(4):312-315.
19Yen YM,Kocher MS.Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children.Surgical technique.J Bone Joint Surg(Am),2008,90Suppl2Pt1:20-30.
20Lee YH,Lee SK,Kim BS.Three lateral divergent or parallel pin fi xa-tions for the treatment of displaced supracondylar humerus fractures in children.J Pediatr Orthop,2008,28(4):417-422.
21Larson L,Firoozbakhsh K,Passarelli R,et al.Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures.J Pediatr Orthop,2006,26(5):573-578.
22Zamzam MM,Bakarman KA.Treatment of displaced supracondylar humeral fractures among children:crossed versus lateral pinning.In-jury,2009,40(6):625-630.
版权所有：© 2023 中国地质图书馆 中国地质调查局地学文献中心