Furrer M, Mark G, Rüedi T
Z Unfallchir Versicherungsmed Berufskr. 1989;82(4):264-5.
33 children with displaced SFH were all treated operatively by open reduction and internal fixation or closed reduction and percutaneous pinning. A follow-up study was performed on average 29 (range 3-63) months after the injury. In 18% of the cases an initial injury of the neurovascular structures was observed and documented during the operation. 32 times open reduction and internal fixation by K-wires was performed, only once, closed reduction and percutaneous pinning was attempted. In the presence of a preoperative neurologic deficit, the nerves were always visualised, never, however, a nerve suture was necessary. In one case we had to reconstruct both the arteria brachialis and radialis because of intima lesions with total obstruction of the vessels. The average time of hospitalization was 9 days, which includes the time for removal of the pins, which was usually performed about 4,5 weeks later simultaneously with the removal of plaster. Using Innocenti's criteria, 27 of 30 reviewed patients had an excellent result, 3 had a good result. Early complications due to the operation such as wound healing problems, infection or nerve lesions did not occur. 3 patients could not be reached any more. We recommend for the management of the displaced SFH open reduction and internal fixation by K-wires as the method of choice. Percutaneous pinning is a valid alternative when closed reduction succeeds easily at the first attempt.
33例移位性单纯肱骨小头骨折患儿均接受切开复位内固定或闭合复位经皮穿针手术治疗。受伤后平均29个月（3 - 63个月）进行随访研究。18%的病例在手术中观察并记录到神经血管结构的初始损伤。行克氏针切开复位内固定32次，仅尝试1次闭合复位经皮穿针。术前存在神经功能缺损时，总能看到神经，但从未需要进行神经缝合。1例因血管内膜损伤导致血管完全阻塞，不得不重建肱动脉和桡动脉。平均住院时间为9天，包括拔针时间，拔针通常在约4.5周后与拆除石膏同时进行。根据因诺琴蒂标准，30例接受评估的患者中27例结果为优，3例为良。未发生因手术导致的早期并发症，如伤口愈合问题、感染或神经损伤。3例患者无法再联系到。我们建议，对于移位性单纯肱骨小头骨折的治疗，克氏针切开复位内固定为首选方法。若首次尝试闭合复位容易成功，则经皮穿针是一种有效的替代方法。
