摘要
目的探讨闭合复位经皮克氏针内固定+Ⅱ期神经探查术治疗儿童闭合性Ⅲ型肱骨髁上骨折并桡神经损伤的临床疗效。方法选取安徽省儿童医院2012年8月-2018年12月采用闭合复位经皮克氏针内固定治疗的42例闭合性Ⅲ型肱骨髁上骨折并桡神经损伤儿童,其中8例行Ⅱ期神经探查术,随访9~82个月(平均50.3个月)。根据Flynn肘关节功能和桡神经功能评定标准进行疗效评价。结果本组患儿42例,骨折术后1~2个月,X线检查均示骨性愈合,且无并发症。按照Flynn肘关节功能评定标准:优35例,良5例,可2例,优良率为95.23%。骨折术后2~3个月,根据桡神经功能评定标准,42例患儿中优27例,良7例,差8例,优良率为80.95%。评定为差的8例患儿,行Ⅱ期桡神经探查术,随访6~80个月,结果均为优。结论采用闭合复位经皮克氏针内固定治疗儿童闭合性Ⅲ型肱骨髁上骨折并桡神经损伤,手术操作安全简单、创伤小、肘关节功能恢复好。骨折术后建议观察3个月,多数患儿桡神经功能恢复好;若桡神经功能仍未恢复者,则行Ⅱ期桡神经探查术,也可获得满意疗效。
Objective To investigate the clinical efficacy of closed reduction and percutaneous Kirschner wire fixation plus stage Ⅱ nerve exploration in the treatment of closed Gartland type Ⅲ humeral supracondylar fracture with radial nerve injury in children. Methods Closed reduction and percutaneous Kirschner wire fixation were performed in 42 children suffered from closed Gartland type Ⅲ humeral supracondylar fracture with radial nerve injury. Among them, 8 cases were underwent stage Ⅱ nerve exploration. All patients were followed up from 9 to 82 months(mean 50.3 months). The therapeutic effect was evaluated according to Flynn elbow joint function and radial nerve function assessment criteria. Results X-ray examination showed that 42 patients gained bone union without complications from 1 to 2 months after operation of fracture, and the Flynn elbow joint functional assessment criteria showed that there were 35 excellent cases, 5 good cases and 2 fair cases, with the excellent and good rate 95.23%. There were 27 excellent, 7 good and 8 poor according to the radial nerve function assessment criteria 2 to 3 months after operation of fracture, the excellent and good rate was 80.95%. Eight poor cases were underwent stage Ⅱ nerve exploration and the results were excellent after follow-up for 6 to 80 months. Conclusion It’s simple and safe with small trauma and good recovery of elbow joint function to treat closed Gartland type Ⅲ humeral supracondylar fracture with radial nerve injury in children using the closed reduction and percutaneous Kirschner wire fixation. It is recommended to observe 3 months after fracture operation, the radial nerve function of most children recovered well. If the function of the radial nerve has not been restored, stage Ⅱ radial nerve exploration should be performed, and satisfactory results can be obtained.
作者
袁毅
金瑞
姚杰
李阳
孙军
YUAN Yi;JIN Rui;YAO Jie;LI Yang;SUN Jun(Department of Orthopedics,Anhui Provincial Children's Hospital,Provincial Children's Hospital of Anhui Medical University,Hefei,Anhui 230051,China)
出处
《中华全科医学》
2020年第2期185-187,276,共4页
Chinese Journal of General Practice
基金
安徽省科技攻关计划项目(1501041159)。
关键词
儿童肱骨髁上骨折
桡神经损伤
神经探查
闭合复位
内固定
Humeral supracondylar fracture in children
Radial nerve injury
Nerve exploration
Closed reduction
Internal fixation
