前侧入路手术治疗儿童肱骨髁上骨折

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1、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

2、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

3、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Treatmentofhumeralsupracondylarfracturesinchildrenviaanteriorapproachsurgeries.SUNKe,TANGSheng-ping,XuJiang-long,etal.DepartmentofPediatricSu

4、rgery,ShenzhenChildren’Hospital,Shenzhen,518026,China.[Abstract]ObjectiveToinvestigateintotheindications,advantagesaswellasthemanipulationofcomplicationsintreatmentofhumeralsupracondylarfracturesinchildrenviaanteriorapproachsurgeries.MethodThestudywascarriedouton32casesincluding25ma

5、lesandsevenfemaleswithanaverageageof4.6.Allthecasessufferedfromfallinginjuriesandfourofthemweretransferredtoourhospitalafterfailuresofmanipulativereductionsinotherhospitals.Bydifferentclassificationstandards,thesufferingsincludedfouropenfracturesand28closedfractures;27extension-type

6、fractures(allofGartlandⅢtype)andfiveflexion-typefractures;15withulnardeviation,ninewithradialdeviationandeightwithrotation.Onadmission,threecasessufferedfromassociatedinjuriesofradialnerves,sixfrommediannervesandonefromulnarnerves;sixpatientshadearly-stagemanifestationsofosteofascia

7、lcompartmentsyndrome.Debridementandemergentopensurgeriesunderanesthesiawereconductedonchildrenwithopenfracturesandhumeralarterycompressionmanifestations;skintractionorolecranonskeletaltractiontreatmentandsurgicaltreatmentafterfourtosevendays(fivedaysinaverage)wereconductedontheother

8、children.Thenaccord