Preis J
Oddĕlení dĕtské chirurgie FN, Hradec Králové.
Rozhl Chir. 2000 Aug;79(8):357-63.
The most frequent cause of the compartment syndrome with subsequent Volkmann's contracture of the upper extremity in children is a supracondylar fracture of the humerus. Often it is being associated by some with the concurrent injury and obliteration of the brachial artery. In the majority of cases of Volkmann's contracture in children with dislocated supracondylar fractures of the humerus, described in the available literature, the development of Volkmann's contracture was preceded by reduction of the fracture and fixation with bandage or in cast with the elbow in flexion. The aim of this study work was to evaluate the impact of specific methods of treatment on the development of Volkmann's contracture. No Volkmann's contracture was observed in a group of 257 patients with displaced supracondylar fracture of the humerus at the authors department from 1984 till 1999 while 7 children with obliteration of the brachial artery were successfully treated without an operation. The development of Volkmann's contracture can be successfully prevented for patients with the displaced supracondylar fracture of the humerus. Minimal elbow flexion, careful manipulation during closed reduction, stabilisation of fragments by percutaneous pinning and careful clinical follow-up are the crucial factors in the prevention of compartment syndrome in this context.
儿童上肢骨筋膜室综合征继发Volkmann挛缩最常见的原因是肱骨髁上骨折。一些人常将其与肱动脉同时损伤和闭塞联系在一起。在现有文献中描述的大多数肱骨髁上骨折脱位的儿童Volkmann挛缩病例中，Volkmann挛缩的发生之前都有骨折复位并用绷带或石膏固定，且肘部处于屈曲位。本研究工作的目的是评估特定治疗方法对Volkmann挛缩发生的影响。1984年至1999年，作者所在科室的257例肱骨髁上移位骨折患者均未观察到Volkmann挛缩，同时7例肱动脉闭塞的儿童患者未经手术即成功治愈。对于肱骨髁上移位骨折患者，Volkmann挛缩的发生是可以成功预防的。最小程度的肘部屈曲、闭合复位时的小心操作、经皮穿针固定骨折碎片以及仔细的临床随访是在此情况下预防骨筋膜室综合征的关键因素。
