CAJ | 학술논문

目的：探讨急诊闭合复位经皮克氏针内固定治疗GartlandⅡ-Ⅲ型儿童肱骨髁上骨折的临床疗效及相关危险因素分析。方法：回顾分析2008年1月至2013年6月急诊行闭合复位经皮克氏针交叉固定治疗112例GartlandⅡ-Ⅲ型儿童肱骨髁上骨折的临床资料。其中男72例，女40例；年龄2～11岁，平均6.2岁；GartlandⅡ型骨折74例，Ⅲ型38例；受伤至手术时间2.5～8 h，平均4.6 h。术后伸肘100°石膏固定4～6周后拆除石膏、拔除克氏针，行功能锻炼。结果：112例术后获得随访，时间6～60个月，平均12个月。所有骨折达到骨性愈合，术后末次随访按Flynn肘关节功能评价，优86例，良23例，一般3例，优良率97.3%。3例发生轻度肘内翻畸形，无须矫形处理。无针道感染、医源性尺神经损伤、骨筋膜室综合征及Volkmann缺血性挛缩等并发症发生。结论：闭合复位经皮克氏针固定具有维持复位确切、固定牢靠、并发症少、急诊手术患儿痛苦少、闭合复位成功率高等优点，是治疗移位型儿童肱骨髁上骨折安全、有效的方法。
목적：탐토급진폐합복위경피극씨침내고정치료GartlandⅡ-Ⅲ형인동굉골과상골절적림상료효급상관위험인소분석。방법：회고분석2008년1월지2013년6월급진행폐합복위경피극씨침교차고정치료112례GartlandⅡ-Ⅲ형인동굉골과상골절적림상자료。기중남72례，녀40례；년령2～11세，평균6.2세；GartlandⅡ형골절74례，Ⅲ형38례；수상지수술시간2.5～8 h，평균4.6 h。술후신주100°석고고정4～6주후탁제석고、발제극씨침，행공능단련。결과：112례술후획득수방，시간6～60개월，평균12개월。소유골절체도골성유합，술후말차수방안Flynn주관절공능평개，우86례，량23례，일반3례，우량솔97.3%。3례발생경도주내번기형，무수교형처리。무침도감염、의원성척신경손상、골근막실종합정급Volkmann결혈성련축등병발증발생。결론：폐합복위경피극씨침고정구유유지복위학절、고정뢰고、병발증소、급진수술환인통고소、폐합복위성공솔고등우점，시치료이위형인동굉골과상골절안전、유효적방법。
Objective:To analyze the clinical effect and related risk factors of Gartland type II-III supracondylar fractures of humerus in children in the emergency closed reduction and percutaneous Kirschner wire fixation. Methods:From January 2008 to June 2013,112 children of Gartland type II to III supracondylar humeral fractures were treated in children in emergency closed reduction and percutaneous K wire fixation,including 72 males and 40 females with an average age of 6.2 years old rang?ing from 2 to 11 years old. Among them,74 cases were in Gartland typeⅡfractures,38 cases were in typeⅢ;The duration from injury to surgery time was 2.5 to 8 hours(averaged 4.6 hours). Elbow cast was applied after operation with the elbow extended of 100 degrees for 4 to 6 weeks,then the gypsum and Kirschner wires were removed. Results:All patients were follow-up from 6 to 60 months(averaged 12 months). All fractures reached clinical healing. The final follow up was assessed by Flynn criteria,the result was excellent in 86 cases,good in 23 cases,general in 3 cases,excellent and good rate was 97.3%. Three patients had mild cubitus varus deformity without orthopedic treatment. No pin tract infections,iatrogenic ulnar nerve injury,compartment syn?drome,and complications such as Volkmann ischemic contracture occurred. Conclusion:Closed reduction and percutaneous Kirschner wire fixation had advantages of exact reduction,firm fixation,fewer complications,less pain in children undergoing emergency surgery,and high success rate,so it is a safe and efficient treatment for humeral supracondylar fracture in children.