CAJ | 학술논문

目的：探讨儿童肱骨髁上骨折并血管神经损伤延迟治疗术后的疗效。方法分析我院治疗的23例儿童肱骨髁上骨折完全移位合并血管、神经损伤延迟治疗的患儿资料，术前高度怀疑神经损伤20例，其中桡神经损伤6例，正中神经损伤13例，1例正中神经伴发尺神经损伤。19例术前出现桡动脉搏动不能触及或搏动减弱情况。入院后对22例伴有严重神经或血管损伤的患儿在1~8 h内行手术治疗，选择克氏针内固定+石膏或外固定架外固定。结果22例患儿术后达解剖复位，20例患儿切口I期愈合，2例切口Ⅱ期愈合，无感染及肘关节功能障碍。19例血管损伤患儿，术后2周内18例恢复较好，桡动脉搏动正常，1例因活动不当致血管再次断裂，经再次手术后恢复较好，术后6个月复查桡动脉损伤症状消失，触及桡动脉搏动良好。3例桡神经损伤患儿术后3个月症状完全消失；1例术后6个月症状基本消失。8例正中神经损伤患儿术后6个月神经功能基本恢复，1例伴有尺神经损伤的术后3个月无明显改善，1例再次出现神经症状，2例患儿均行二次手术神经探查，分别发现正中神经部分离断和正中神经被周围软组织增生压迫出现神经症状，分别行神经探查吻合及周围软组织松解术，2例患儿术后9个月复查时神经损伤症状基本消失。结论对于儿童肱骨髁上骨折并血管损伤延迟治疗的病例因术后并发症较多，主张早期行手术治疗，可获得较好疗效。
목적：탐토인동굉골과상골절병혈관신경손상연지치료술후적료효。방법분석아원치료적23례인동굉골과상골절완전이위합병혈관、신경손상연지치료적환인자료，술전고도부의신경손상20례，기중뇨신경손상6례，정중신경손상13례，1례정중신경반발척신경손상。19례술전출현뇨동맥박동불능촉급혹박동감약정황。입원후대22례반유엄중신경혹혈관손상적환인재1~8 h내행수술치료，선택극씨침내고정+석고혹외고정가외고정。결과22례환인술후체해부복위，20례환인절구I기유합，2례절구Ⅱ기유합，무감염급주관절공능장애。19례혈관손상환인，술후2주내18례회복교호，뇨동맥박동정상，1례인활동불당치혈관재차단렬，경재차수술후회복교호，술후6개월복사뇨동맥손상증상소실，촉급뇨동맥박동량호。3례뇨신경손상환인술후3개월증상완전소실；1례술후6개월증상기본소실。8례정중신경손상환인술후6개월신경공능기본회복，1례반유척신경손상적술후3개월무명현개선，1례재차출현신경증상，2례환인균행이차수술신경탐사，분별발현정중신경부분리단화정중신경피주위연조직증생압박출현신경증상，분별행신경탐사문합급주위연조직송해술，2례환인술후9개월복사시신경손상증상기본소실。결론대우인동굉골과상골절병혈관손상연지치료적병례인술후병발증교다，주장조기행수술치료，가획득교호료효。
Objective To analyze efficacy of delayed treatment of supracondylar fracture of humerus in children with neurovascular injury. Methods 23 clinical data of children undergoing delayed treatment of supracondylar frac-ture of humerus with neurovascular injury were analyzed. Nerve injury occurred in 20 cases,including 6 cases of radial nerve injury,13 cases of median nerve injury,1 case of median nerve combined with ulnar nerve injury. Radial artery pulse couldnˊt be touched or pulse weakened before surgery in 19 cases. 22 patients with severe nerve or vascular dam-age underwent operation within 1 to 8 h. Kirschner wire internal fixation plus plaster or external fixation were chosen. Results 22 cases got reduction,in which 20 patients got incision healing stage I and 2 cases got incision healing stageⅡ without infection and elbow dysfunction. Of 19 cases of vascular injury,18 cases recovered well two weeks after op-eration with normal radial artery pulse. Blood vessel ruptured again due to improper activities in 1 case,which recov-ered well after reoperation,and radial artery injury symptoms disappeared with good radial artery pulse 6 months after operation. Symptoms disappeared in 3 cases with radial nerve injury 3 months after operation. Symptoms disappeared basically in 1 case 6 months after operation. Neural function recovered basically in 8 children with median nerve injury 6 month after operation. No obvious improvement occurred in 1 case with ulnar nerve injury. Neural symptoms ap-peared in 1 case again. Nerve exploration was performed again in these 2 cases. Median nerve ruptured partly in 1 case and neural symptom occurred because of peripheral soft tissue hyperplasia. Nerve exploration anastomosis and periph-eral soft tissue lysis were performed respectively. Neural injury symptoms appeared 9 months after operation. Conclu-sion Delayed treatment of supracondylar fracture of humerus in children with neurovascular injury need to be per-formed as early as possible for the many complications.