CAJ | 학술논문

目的：探讨分次中医手法复位结合经皮克氏针固定治疗幼儿肱骨远端全骺分离的有效性和安全性。方法回顾性分析2009年1月至2013年6月本院就诊的35例幼儿肱骨远端全骺分离病例，年龄0.5～5岁，平均2.2岁。男性患儿22例，女性13例；左侧18例，右侧17例。致伤原因：跌倒摔伤27例，高处坠落伤8例；Delee分型：A型11例，B型15例，C型9例；治疗时间为伤后1～10天。受伤后急诊给予手法复位，所有病例骨折移位明显改善，其中25例复位较为满意，复位后收住入院，延期在麻醉下再次手法复位结合经皮克氏针内固定术。术后屈肘90°石膏固定。术后随访7个月～4年，平均2.6年。结果本组35例手法复位经皮克氏针固定，无1例行切开复位。未发生针道感染、骨折再移位、延迟愈合或不愈合、医源性尺神经损伤及骨筋膜室综合症等并发症。随访肘关节功能优24例，良5例，可4例，差2例，优、良率为82.9%，2例随访1年出现明显的肘内翻畸形。结论幼儿肱骨远端全骺分离易于误诊，治疗难度大，急诊即给手法复位石膏外固定，减轻疼痛，防止肿胀加重，避免骨筋膜室综合症，增加再次复位经皮克氏针固定的成功率。是幼儿肱骨远端全骺分离治疗安全有效的方法之一。
목적：탐토분차중의수법복위결합경피극씨침고정치료유인굉골원단전후분리적유효성화안전성。방법회고성분석2009년1월지2013년6월본원취진적35례유인굉골원단전후분리병례，년령0.5～5세，평균2.2세。남성환인22례，녀성13례；좌측18례，우측17례。치상원인：질도솔상27례，고처추락상8례；Delee분형：A형11례，B형15례，C형9례；치료시간위상후1～10천。수상후급진급여수법복위，소유병례골절이위명현개선，기중25례복위교위만의，복위후수주입원，연기재마취하재차수법복위결합경피극씨침내고정술。술후굴주90°석고고정。술후수방7개월～4년，평균2.6년。결과본조35례수법복위경피극씨침고정，무1례행절개복위。미발생침도감염、골절재이위、연지유합혹불유합、의원성척신경손상급골근막실종합증등병발증。수방주관절공능우24례，량5례，가4례，차2례，우、량솔위82.9%，2례수방1년출현명현적주내번기형。결론유인굉골원단전후분리역우오진，치료난도대，급진즉급수법복위석고외고정，감경동통，방지종창가중，피면골근막실종합증，증가재차복위경피극씨침고정적성공솔。시유인굉골원단전후분리치료안전유효적방법지일。
Objective To study the efficacy and safety of combination therapy which is comprised of traditional Chinese medicine based mul-ti-stage manipulative reduction and percutaneous kirschner-wire fixation in the management of complete distal humeral epiphyseal separation in chil-dren. Methods A retrospective analysis was made of the data of 35 cases(22 male and 13 female) of complete distal humeral epiphyseal separation in our hospital from 2009 to 2013, the age ranged from 6 months to 5 years (mean 2.2 years). Eighteen cases of complete distal humeral epiphyseal separation were at the left side, the other 17 cases were at the right side. Causes: 27 cases belonged to falling injury, 8 cases belonged to high falling injury; According to Delee’s classification, 11 cases belonged to type A, 15 to type B and 9 to type C; the course was from 24 hours to 10d. Manual reduction was carried out in the emergency department after injury, fracture displacement improved significantly, 25 cases obtained satisfactory reduc-tion, and the patients were hospitalized after reduction. Delayed surgery was carried out with the combination treatment of manual reduction and per-cutaneous kirschner-wire fixation. When the surgery finished, elbow flexed to 90 degrees, then fixed with plaster cast. The patients were followed-up from 7 months to 4 years (mean 2.6 years). Results All the patients in this research obtained the combination treatment of manual reduction and percutaneous kirschner-wire fixation, none of them received open reduction. There were no complications from the operation, such as pin site infec-tion, postoperative displacement, iatrogenic ulnar nerve injury and osteofascial compartment syndrome, etc. In the process of the follow-up, They were assessed by function of elbow joint, and were classified as excellent (24), good (5), fair(4) and poor(2), the excellent rate was 82.9%. In the first year of follow-up, cubis varus were encountered in 2 cases. There was no delayed union and disunion. Conclusion Complete distal humeral epiphyseal separation in children can be easily misdiagnosed, and the treatment for this disease is also very difficult. Plaster fixation after manual reduction in the emergency department can obtain plenty of benefits, such as reduced overall pain, decreased swelling and occurrence of osteofascial compartment syn-drome;it also increased the success rate of the combination treatment of manual reduction and percutaneous kirschner-wire fixation. This is one of the safe and effective therapies to treat complete distal humeral epiphyseal separation in children.