Ersan Onder, Gonen Emel, İlhan Recep Dogan, Boysan Ersan, Ates Yalim
Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
J Pediatr Orthop B. 2012 Mar;21(2):121-6. doi: 10.1097/BPB.0b013e32834dd1b2.
Eighty-four patients who underwent open reduction and Kirschner wire (K-wire) fixation for supracondylar humerus fractures through anterior or lateral approach with or without additional medial incisions were compared with regard to complications and end results. A total of 46 patients were operated through the anterior and 38 through the lateral approach. In lateral approach cases, medial incision was added only in those patients in whom the medial condyle and therefore the ulnar nerve were not easily distinguished due to excessive oedema. All the fractures were Gartland type III extension fractures. The patient series was consecutive, and lateral approach had a longer follow-up of 89 months (70-134 months); the incision protocol was changed approximately mid-series to the anterior approach, and therefore a shorter follow-up time of only 50 months (24-84 months) was possible. All patients were treated according to the same postoperative protocol. A follow-up examination was performed and all the patients were evaluated according to Flynn's criteria; loss of flexion or extension clinically, any deviation of the carrying angle radiologically, and the appearance of the incision scar were evaluated. According to the above parameters, results were excellent in 19, good in 18, and fair in one in the lateral incision group, whereas in the anterior incision group, excellent results were obtained in 31 patients and good results in 15 of them. Cosmetically, two patients in the lateral incision group had hypertrophic scar tissue, whereas the anterior incisions were barely noticeable as they were included into the flexion crease. In conclusion, we can say that anterior incision when open reduction is needed in pediatric supracondylar fractures offer the advantage of a smaller scar and easy access to structures that might be injured between the fractured fragments.
对84例因肱骨髁上骨折采用前路或外侧入路切开复位并克氏针固定（有或无附加内侧切口）的患者，就并发症和最终结果进行了比较。共有46例患者采用前路手术，38例采用外侧入路手术。在外侧入路的病例中，仅对那些因水肿过度而难以区分内侧髁及尺神经的患者增加内侧切口。所有骨折均为GartlandⅢ型伸直型骨折。患者系列为连续性病例，外侧入路组随访时间更长，为89个月（70 - 134个月）；切口方案在系列病例大约中间阶段改为前路入路，因此前路入路组随访时间较短，仅为50个月（24 - 84个月）。所有患者均按照相同的术后方案进行治疗。进行了随访检查，并根据弗林（Flynn）标准对所有患者进行评估；评估临床屈伸功能丧失情况、放射学上提携角的任何偏差以及切口瘢痕外观。根据上述参数，外侧切口组19例结果为优，18例为良，1例为可；而在前路切口组，31例患者结果为优，15例为良。在外观方面，外侧切口组有2例患者出现瘢痕组织增生，而前路切口因位于屈侧皱襞内几乎难以察觉。总之，我们可以说，小儿肱骨髁上骨折需要切开复位时，前路切口具有瘢痕较小且易于显露骨折碎片间可能受损结构的优点。
