摘要
目的：通过改进后的治疗方法降低肘内翻的发生率。方法：复位时使骨折端桡侧嵌插、尺侧分离，前臂屈曲旋前位固定，矫正尺偏及尺侧倾斜，以恢复骨折段正常轴线，尺偏型矫枉过正成轻度桡偏。需手术者，采用改进的后内侧手术入路，不切断肱三头肌。当尺侧骨皮质塌陷明显，复位后尺侧骨折端遗留间隙过大时，同时截除部分桡侧骨折端骨质，其截除长度相当于尺侧骨皮质塌陷的高度，并需术中测携带角，以防截除桡侧骨质过多造成肘外翻。判定复位优良的标准是恢复骨折段的正常轴线，不是骨折断端的局部对正、对齐。结果：２１０例中１７５例得到１～１４年随访，平均４．４年。通过摄肘关节标准正、侧位Ｘ线片测量数据（ｘ±ｓ）：ＣＡ角１５．２７°±３．８１°，ＢＡ角２８．４１°±３．１７°，肘内翻发生率３．４３％。结论：从生物力学及小儿肱骨髁上部解剖学观测角度，肘内翻发生虽有其客观因素，但治疗时只要彻底纠正尺偏倾斜并维持复位后的稳定，可使肘内翻发生率降至最低限度。
bjective: To investigate the methods for the improvement for the treatment of supracondylar fracture in children,chiefly to lower down the rate of occurrence of cubitus varus. Methods:During the reduction of the fracture,the authors incarcerated the radial side of the fractured segment of the humerus and separated the ulnar side. The forearm was then flexed and fixation of the forearm in pronation. Correction of the ulnar deviation was done so as to keep the normal axis of the fractured segment. The authors preferred over correction of the ulnar deviation into radial deviation. Those cases with surgical indications,an improved posterior medial approach was used,without section of the triceps. When there is remarkable collapse of the humerus cortex over the ulnar aspect,a gap is usually left after reduction;resection of the radial side of the fracture segment of the humerus is then necessary to compensate the gap over the ulnar side. Intraoperative measurement of the carrying angle is advisable,so as to prevent the occurrence of cubitus valgus due to more than enough resection of the radial side of the fractured segment. The determination of a satisfied reduction depends upon the restoration the normal axis of the fractured segment,rather than the real alignment of the fractured segments. Results: One hundred and seventyfive cases among the 210 cases had followup of 1-14 years,with an average of 44 years. X-ray examination with the A-P and Lateral views,revealed CA angle 1527 degrees ±381 degrees,BA angle 2841 degrees ±317 degrees. Cubitus varus occurred in 343%. Conclusion:From the biomechanical point of view and the anatomical observation of the supracondylar portion in children,the objective factors for the occurrence of cubitus varus do exist;however,during the treatment of these fracture,if strict correction of the ulnar deviation is done and stability is maintained during the fixation, the rate of occurrence of cubitus varus can be kept at a minimum.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
1998年第8期463-466,共4页
Chinese Journal of Orthopaedics
关键词
肱骨髁上骨折
儿童
肘内翻
治疗
umerus Fractures Postoperative complications
