Mehlman C T, Crawford A H, McMillion T L, Roy D R
University of Cincinnati, Children's Hospital Medical Center, Department of Orthopedic Surgery, Ohio, USA.
Acta Orthop Belg. 1996;62 Suppl 1:41-50.
A retrospective review of 115 patients treated surgically for displaced supracondylar humeral fractures was conducted. All patients had a minimum of 2 years' follow-up (range 2 to 7 years). According to a modified Gartland (19) classification system, 18.3% were type II (21/115), 77.4% were type III (89/115), and 4.3% (5/115) type IV supracondylar fractures. Twelve percent (14/115) of patients presented with neurapraxias, with the radial nerve being the most commonly affected. Sixty percent (69/115) of patients were treated with a crossed K-wire configuration, while another 30% (35/115) received two lateral pins as their internal fixation. The remaining 10% (11/115) of patients were treated with a variety of "other" pin configurations, including four lateral pins, three lateral pins, one lateral and one medial pin constructs. Eighty patients were treated in the lateral position with the C-arm horizontal, while 35 were treated supine using the C-arm base as the operating table. There were 23 complications noted, with 5 children with cubitus varus, 4 children with cubitus valgus, 3 pin-tract infections requiring antibiotic therapy, 3 failed closed reductions in the operating room that required formal open reduction and internal fixation, and 2 patients experiencing pin breakage. For a subgroup of 77 patients, satisfactory clinical and radiographic data were available for the purpose of evaluating these patients with Flynn's supracondylar rating scale as well as Baumann's angle (15). Eighty-three percent had good or excellent results, 14- had fair results, and 3% had poor results. At completion of bony healing 9 children fell outside the normal range for Baumann's angle established by Williamson et al. (45). Five children were noted to have cubitus varus (Baumann's angles ranging from 83 degrees to 90 degrees) and 4 children had significant cubitus valgus (Baumann's angles ranging from 60 degrees to 63 degrees).
对115例因肱骨髁上骨折移位而接受手术治疗的患者进行了回顾性研究。所有患者至少随访2年（范围为2至7年）。根据改良的加特兰（19）分类系统，18.3%为II型（21/115），77.4%为III型（89/115），4.3%（5/115）为IV型髁上骨折。12%（14/115）的患者出现神经失用症，其中桡神经受影响最为常见。60%（69/115）的患者采用交叉克氏针固定，另有30%（35/115）接受两根外侧钢针作为内固定。其余10%（11/115）的患者采用各种“其他”钢针固定方式，包括四根外侧钢针、三根外侧钢针、一根外侧和一根内侧钢针结构。80例患者采用C形臂水平的侧卧位进行治疗，而35例患者采用C形臂底座作为手术台的仰卧位进行治疗。共记录到23例并发症，其中5例儿童出现肘内翻，4例儿童出现肘外翻，3例针道感染需要抗生素治疗，3例在手术室闭合复位失败需要进行正式的切开复位内固定，2例患者出现钢针断裂。对于77例患者的亚组，有满意的临床和影像学数据，以便用弗林髁上评分量表以及鲍曼角（15）对这些患者进行评估。83%的患者结果良好或优秀，14%的患者结果一般，3%的患者结果较差。在骨愈合完成时，9名儿童的鲍曼角超出了威廉姆森等人（45）确定的正常范围。5名儿童被发现有肘内翻（鲍曼角范围为83度至90度），4名儿童有明显的肘外翻（鲍曼角范围为60度至63度）。
