CAJ | 학술논문

目的分析漂浮肘受伤的机制,依据病理解剖的类型采取相应的治疗方案,评价儿童漂浮肘治疗的疗效,探讨儿童漂浮肘的治疗体会.方法对2005年6月至2012年10月在我院治疗的25例儿童漂浮肘进行回顾性研究.25例儿童漂浮肘损伤病例中,男17例,女8例,平均年龄7.5岁.肱骨髁上骨折25例,Garland Ⅰ型4例,Ⅱ型10例,Ⅲ型11例.桡骨骨折25例,桡骨干骨折3例,桡骨远侧干骺端骨折14例,累及桡骨远端骨骺的骨折8例,尺骨骨折11例.伴有桡神经损伤3例,正中神经损伤1例.Ⅰ型肱骨髁上骨折行手法复位石膏固定,Ⅱ型、Ⅲ型的肱骨髁上骨折予以闭合复位克氏针固定,对桡骨骨折依据病理解剖的类型行骨折闭合复位克氏针固定、弹性髓内钉固定或骨折切开复位钢板内固定.结果依据修订Flynn表对治疗效果作出客观评价,22例患儿肘关节屈伸和前臂旋转的功能正常,2例患儿患侧肘关节有10°屈曲伸直受限,10°前臂旋转受限,1例患儿患侧肘关节有15°屈曲受限,伴有12°前臂旋转受限,无肘内外翻畸形.结论根据漂浮肘的病理解剖类型采用相应的治疗措施,治疗效果是满意的.
목적 분석표부주수상적궤제,의거병리해부적류형채취상응적치료방안,평개인동표부주치료적료효,탐토인동표부주적치료체회.방법 대2005년6월지2012년10월재아원치료적25례인동표부주진행회고성연구.25례인동표부주손상병례중,남17례,녀8례,평균년령7.5세.굉골과상골절25례,Garland Ⅰ형4례,Ⅱ형10례,Ⅲ형11례.뇨골골절25례,뇨골간골절3례,뇨골원측간후단골절14례,루급뇨골원단골후적골절8례,척골골절11례.반유뇨신경손상3례,정중신경손상1례.Ⅰ형굉골과상골절행수법복위석고고정,Ⅱ형、Ⅲ형적굉골과상골절여이폐합복위극씨침고정,대뇨골골절의거병리해부적류형행골절폐합복위극씨침고정、탄성수내정고정혹골절절개복위강판내고정.결과 의거수정Flynn표대치료효과작출객관평개,22례환인주관절굴신화전비선전적공능정상,2례환인환측주관절유10°굴곡신직수한,10°전비선전수한,1례환인환측주관절유15°굴곡수한,반유12°전비선전수한,무주내외번기형.결론 근거표부주적병리해부류형채용상응적치료조시,치료효과시만의적.
Objective To analyze the mechanisms of injury,adopt the therapeutic regimen according to the pathological anatomy,evaluate the therapeutic effects of floating elbow,and present our experience in the management of "floating elbow" in children.Methods From 2005 to 2012,25 cases (17 boys and 8 girls) with average age of 7.5 years were retrospectively evaluated after treatment of their floating elbow injuries.Twenty-five cases were with supracondylar fracture of the humerus,including Gartland type Ⅰ in 4 patients,type Ⅱ in 10 cases,and type Ⅲ in 11 case.Eleven cases were with both the radius and ulna fractures,and 14 with simple radius fractures.The radius fractures included shaft of radius fractures in 3 cases,metaphysis fractures in 14 cases,and epiphyseal fractures in 8 cases.Three cases had radial nerve injury,and one case had median nerve injury.All patients with Gartland type Ⅱ/Ⅲ supracondylar fractures were treated with primary closed reduction and percutaneous Kirschner wire pinning,while cases with type Ⅰ were treated with plaster.Some patients with displaced radius fractures were treated with primary closed reduction and percutaneous Kirschner wire pinning or elastic intramedullary nail fixation.Some cases were treated with open reduction and internal fixation.Results According to the modified Flynn criteria,two patients had 10 deficiency of the range of elbow motion and 10 deficiency of forearm supination,one case had 15 limitation of elbow flexion and 12 limitation of forearm supination,and the remaining 22 cases had satisfactory elbow and forearm movements.No residual varus and valgus were found in all cases except ligament hyperlaxity.Conclusions Management of floating elbow according to the pathological anatomy is effective with satisfactory functional results.