Choi Paul D, Melikian Rojeh, Skaggs David L
Childrens Orthopaedic Center, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027, USA.
J Pediatr Orthop. 2010 Jan-Feb;30(1):50-6. doi: 10.1097/BPO.0b013e3181c6b3a8.
The aims of this study were to determine how often fracture reduction alone restored pulses and vascular perfusion in displaced supracondylar humerus fractures with absent distal pulses on presentation, and whether any preoperative factors were associated with the need for vascular repair and vascular complications.
We reviewed 1255 supracondylar humerus fractures in children treated operatively over 12 years at one institution. We identified 33 patients who presented with displaced supracondylar humerus fractures and absent distal pulses. We reviewed the management and outcome of these injuries.
Thirty-three (of 1255) patients presented with a pulseless supracondylar humerus fracture (2.6%). The patients were divided into 2 groups: those at presentation whose hand was well perfused (n=24) or poorly perfused (9). None (0 of 24) of the well-perfused patients underwent vascular repair; 3 had open reduction. Of the 21 well-perfused patients undergoing closed reduction and pinning, 11 (of 21) had a palpable pulse after surgery and 10 (of 21) remained pulseless but well perfused; all did well clinically. Of the 9 patients in the poorly perfused group, 4 underwent vascular repair, and compartment syndrome developed in 2 during the postoperative period. In just over half of patients with a poorly perfused hand (5 of 9), fracture reduction alone was the definitive treatment.
In the largest series of children with pulseless displaced supracondylar humerus fractures in the literature, we identify 2 distinct populations, with the perfusion status of the hand at time of presentation correlating significantly with the ultimate need for vascular repair. In patients presenting with a well-perfused hand, fracture reduction alone was sufficient treatment in all 24 (of 24) cases, and no patients developed compartment syndrome. Nearly half of these patients still had an absent palpable pulse but well-perfused hand after closed reduction, yet did well clinically. Patients presenting with a poorly perfused hand are at high risk for vascular repair and compartment syndrome.
本研究的目的是确定在就诊时无远端脉搏的移位性肱骨髁上骨折中，单纯骨折复位恢复脉搏和血管灌注的频率，以及是否有任何术前因素与血管修复需求和血管并发症相关。
我们回顾了一家机构在12年期间接受手术治疗的1255例儿童肱骨髁上骨折病例。我们确定了33例表现为移位性肱骨髁上骨折且无远端脉搏的患者。我们回顾了这些损伤的治疗及结果。
1255例患者中有33例（2.6%）出现无脉搏的肱骨髁上骨折。患者被分为两组：就诊时手部血运良好的患者（n = 24）和血运不佳的患者（9例）。血运良好的患者中无一例（24例中的0例）接受血管修复；3例接受切开复位。在21例接受闭合复位和穿针固定的血运良好的患者中，11例（21例中的）术后可触及脉搏，10例（21例中的）仍无脉搏但血运良好；所有患者临床情况良好。在血运不佳组的9例患者中，4例接受了血管修复，2例在术后发生了骨筋膜室综合征。在手部血运不佳的患者中，略超过一半（9例中的5例）单纯骨折复位即为最终治疗方法。
在文献中关于无脉搏移位性肱骨髁上骨折儿童的最大系列研究中，我们识别出两个不同的群体，就诊时手部的灌注状态与血管修复的最终需求显著相关。对于就诊时手部血运良好的患者，24例（24例中的）单纯骨折复位即为充分治疗，且无患者发生骨筋膜室综合征。这些患者中近一半在闭合复位后仍无可触及的脉搏但手部血运良好，但临床情况良好。就诊时手部血运不佳的患者血管修复和骨筋膜室综合征风险高。
