Özkul Emin, Gem Mehmet, Alemdar Celil, Arslan Hüseyin, Azboy İbrahim, Çelik Velat
Dicle University Faculty of Medicine, Department of Orthopaedics and Traumatology, Diyarbakır, Turkey.
Ulus Travma Acil Cerrahi Derg. 2016 Jan;22(1):84-9. doi: 10.5505/tjtes.2015.83720.
The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures.
Forty-two pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluation included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications.
In 27 patients, radial pulse was palpated following reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) who retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair.
It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.
本研究的目的是评估肱骨髁上骨折后远端脉搏消失患儿的治疗结果。
回顾性评估42例因肱骨髁上骨折接受治疗的无脉搏手部患者。评估内容包括术前和术后神经检查出现的症状、损伤机制、受伤至就诊时间、受伤至手术时间、住院时间以及术后并发症。
27例患者复位后可触及桡动脉搏动。10例患者用多普勒检测到血流，2例患者未检测到血流。这2例患者无缺血表现，术后1天用多普勒检测到血流。3例（7%）患者复位后仍有缺血表现且用多普勒检测不到血流，立即进行了血管探查。1例患者接受了一期缝合，另外2例采用大隐静脉移植和一期修复治疗。
对肱骨髁上骨折后出现无脉搏手部的患者进行重新评估至关重要；对于无缺血或缺血迹象的患者应密切随访，对于仍有缺血迹象的患者应进行一期血管修复治疗。
