Wu Weiping, Li Xu, Shi Qiang, Dai Shuangwu, Tan Wei, Hu Chao
Department of Pediatric Orthopedics, Third Affiliated Hospital of Southern Medical Uuniversity (Academy of Orthopedics of Guangdong Province), Guangzhou 510630, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2014 Aug;34(9):1351-4.
To explore minimally invasive surgical techniques for Gartland type III humeral supracondylar fracture in children and evaluate the outcomes of the patients.
We retrospectively analyzed 62 children (43 boys and 19 girls, aged 1 year and 8 months to 13 years and 2 months, mean 6 years and 3 months) with Gartland type III humeral supracondylar fracture treated in our department from July, 2011 to September, 2013, including 42 with extension-ulnar type humeral supracondylar fracture and 20 with deviation-ulnar type. The injury to operation time ranged from 6 to 48 h with a mean of 13.5 h. Close reduction and percutaneous pinning internal fixation was performed by a single surgeon in all cases with plaster cast fixation for 3 to 4 weeks. The patients were followed up regularly and Flynn elbow scoring criteria was used to evaluate the outcomes.
The mean operation time was 26.8 ± 15.6 min with a mean intraoperative fluoroscopy frequency of 9.2 ± 2.6 and a mean follow-up for 16.5 months (6 to 30 months). Clinical healing was achieved in 3 to 4 weeks without fracture displacement after removal of the internal fixation, and active and passive functional exercise was initiated. According to the Flynn elbow scoring criteria, excellent outcome was achieved in 53 (85%) cases at 3 months in 62 (100%) cases at 6 months after the surgery. No such complications as osteofascial compartment syndrome or vascular injuries occurred in these patients. Three children had alnar nerve injury symptoms after the operation but all recovered in 3 months.
The minimally invasive method with closed reduction and percutaneous pinning internal fixation is feasible for treatment of Gartland type III humerus condyle fracture in children. This approach involves relatively simple operation with shorter operation time, minimal trauma, and less complications after operation, and promotes early functional recovery of the elbow joint.
探讨儿童GartlandⅢ型肱骨髁上骨折的微创手术技术并评估患者预后。
回顾性分析2011年7月至2013年9月在我科治疗的62例GartlandⅢ型肱骨髁上骨折患儿（男43例，女19例，年龄1岁8个月至13岁2个月，平均6岁3个月），其中伸直尺偏型肱骨髁上骨折42例，尺偏型20例。受伤至手术时间为6至48小时，平均13.5小时。所有病例均由同一外科医生行闭合复位经皮穿针内固定术，术后石膏固定3至4周。定期对患者进行随访，采用Flynn肘关节评分标准评估预后。
平均手术时间为26.8±15.6分钟，术中平均透视次数为9.2±2.6次，平均随访16.5个月（6至30个月）。术后3至4周临床愈合，内固定取出后无骨折移位，开始进行主动和被动功能锻炼。根据Flynn肘关节评分标准，术后3个月时53例（85%）疗效为优，术后6个月时62例（100%）疗效为优。这些患者未发生骨筋膜室综合征或血管损伤等并发症。3例患儿术后出现尺神经损伤症状，但均在3个月内恢复。
闭合复位经皮穿针内固定的微创方法治疗儿童GartlandⅢ型肱骨髁上骨折可行。该方法手术操作相对简单，手术时间短，创伤小，术后并发症少，有利于肘关节功能早期恢复。
Zotero 插件