CAJ | 학술논문

目的探讨急诊室手法复位石膏外固定后延期行经皮克氏针内固定治疗儿童Ⅲ型肱骨髁上骨折的方法及必要性.方法回顾性分析2008年2月至2013年2月急诊室手法复位石膏固定后延期经皮克氏针内固定手术治疗189例GartlandⅢ肱骨髁上骨折患儿的临床资料.其中,男118例,女71例;年龄2～13岁,平均6.8岁.受伤至急诊室接受手法复位石膏固定时间0.5～8 h,平均4.8h.手法复位后所有病例骨折前后及侧方移位均有明显改善,其中115例复位较为满意.复位后收住入院,住院后准备2～7 d,平均3.8d,延期行经皮克氏针内固定术.术后屈肘90°石膏固定,3～4周拆石膏、拔除克氏针.术后随访3～48个月,平均12个月.结果本组患儿经急诊室手法复位住院后疼痛VAS评分从平均(6.8±2.3)分下降至(3.2±1.2)分;闭合复位经皮克氏针内固定手术时间10～45min,平均21.4 min.术后随访所有患儿骨折均愈合,未发生骨筋膜室综合征及缺血性肌挛缩;出现轻度肘内翻4例,1例2年后出现严重肘内翻需手术.术前合并神经损伤25例,有24例完全恢复,1例尺神经损伤未完全恢复.术后有尺神经损伤2例,3个月内均恢复.结论急诊室超早期手法复位石膏固定后再进行延期经皮克氏针内固定手术治疗方法可以减轻儿童骨折后的痛苦,提高延期手术的成功率,减少肢体肿胀及骨筋膜室综合征等并发症的发生,有效解决了急诊与非急诊手术的争论,是儿童肱骨髁上骨折治疗一种必要和有效的方法.
목적 탐토급진실수법복위석고외고정후연기행경피극씨침내고정치료인동Ⅲ형굉골과상골절적방법급필요성.방법 회고성분석2008년2월지2013년2월급진실수법복위석고고정후연기경피극씨침내고정수술치료189례GartlandⅢ굉골과상골절환인적림상자료.기중,남118례,녀71례;년령2～13세,평균6.8세.수상지급진실접수수법복위석고고정시간0.5～8 h,평균4.8h.수법복위후소유병례골절전후급측방이위균유명현개선,기중115례복위교위만의.복위후수주입원,주원후준비2～7 d,평균3.8d,연기행경피극씨침내고정술.술후굴주90°석고고정,3～4주탁석고、발제극씨침.술후수방3～48개월,평균12개월.결과 본조환인경급진실수법복위주원후동통VAS평분종평균(6.8±2.3)분하강지(3.2±1.2)분;폐합복위경피극씨침내고정수술시간10～45min,평균21.4 min.술후수방소유환인골절균유합,미발생골근막실종합정급결혈성기련축;출현경도주내번4례,1례2년후출현엄중주내번수수술.술전합병신경손상25례,유24례완전회복,1례척신경손상미완전회복.술후유척신경손상2례,3개월내균회복.결론 급진실초조기수법복위석고고정후재진행연기경피극씨침내고정수술치료방법가이감경인동골절후적통고,제고연기수술적성공솔,감소지체종창급골근막실종합정등병발증적발생,유효해결료급진여비급진수술적쟁론,시인동굉골과상골절치료일충필요화유효적방법.
Objective To investigate the method and necessity of delayed percutaneous pins fixation for type Ⅲ supracondylar fractures of humerus in children after emergency manipulative reduction and plaster fixation.Methods From February 2008 to February 2013,the clinical data of 189 patients with Gartland type Ⅲ supracondylar fractures were reviewed.They underwent delayed percutaneous pinning after emergency manipulative reduction and plaster fixation.There were 118 males and 71 females with a mean age of 6.8 (2-13) years.The average delay between injury and emergency reduction and plaster fixation was 4.8 (0.5-8) hours.Fracture displacement significantly improved after manipulative reduction,including satisfactory reduction (n =115).Then all cases were hospitalized.After preparation for a mean length of 3.8 (0.5-8) days,delayed percutaneous Kirschner wire fixation was performed.Postoperative elbow 90 plaster fixation was applied.Plaster,pins and Kirschner wire were removed after 3-4 weeks.The mean postoperative follow-up period was 12 (3-48) months.Results The mean pain VAS scores decreased from (6.8 ± 2.3) to (3.2 ± 1.2) points.And the mean operative duration of closed reduction and percutaneous pinning fixation was 21.4(10-45) min.All fractures healed without compartment syndrome or ischemic contracture.Among 4 cases of mild cubitus varus,one case of serious elbow varus required surgery after 2 years.And 24/25 cases of preoperative nerve injury fully recovered while one case of ulnar nerve injury had incomplete recovery.Postoperative ulnar nerve injury was restored in 2 cases after 3 months.Conclusions The treatment of delayed percutaneous pin fixation for children type Ⅲ supracondylar fractures after manipulative emergency reduction and ultra-early plaster fixation can relieve pain,improve the success rate of delayed surgery and reduce extremity swelling and complications.It is an effective solution to the controversy of emergency versus non-emergency surgery for supracondylar fractures in children.