医学论文：肘后不同手术入路治疗儿童肱骨髁上骨折

肘后不同手术入路治疗儿童肱骨髁上骨折

【摘要】目的：探讨肘后不同手术入路对儿童肱骨髁上骨折的手术治疗效果。方法：2007年1月-2010年1月收治的100例儿童肱骨髁上骨折患者，50例采取肘后肱三头肌舌状瓣切断入路(a组)，50例采取肘后肱三头肌尺骨上剥离入路(b组)，复位交叉克氏针内固定，据aitken和rorbeck肘关节功能评分标准分析疗效。结果：骨折均获骨性愈合，时间1~3个月，平均2个月，术后肘关节功能总体恢复满意，时间1~4个月，平均2.5个月，优秀80例，良好13例，可7例，差0例，优良率93%。肘后肱三头肌尺骨上剥离入路组的手术时间及功能恢复时间明显短于肱三头肌舌状瓣切断入

路组。结论：肘后不同手术入路治疗儿童肱骨髁上骨折效果均良好，肱三头肌尺骨上剥离入路具有操作简捷、失血量较少、术时短、功能恢复快等优点。

【关键词】手术入路；儿童肱骨髁上骨折；效果

the treatment of children humeral supracondylar fracture with different approach of operation behind elbow joint/chen jun//medical innovation of china，2012，9(11)：106-107 【abstract】objective：to investigate the effect of treatment with different approach of operation in children humeral supracondylar fractures.methods：from january 2007 to january 2010，100 children suffered from humeral supracondylar fractures were investigated.50 cases were

fixation with tongue-shaped operative approach of triceps muscle of arm (group a)，50 cases were fixation with operative approach which peel triceps muscle of arm from ulna (group b).following open reduction of fractures and fixation with crossed k-pinning，all patients were observed during operation and followed-up for an average period of 21 months(range from 12 to 36 months).according to aitken and rorbeck evaluate standard to conclude.results：the average time of healing in all the fractures was 2 months， (from 1 to 3 months)，the average time of healing on motion of the elbow joint was 2.5 months (from 1 to 4 months)，the functional scores were excellent in 80 cases，good in 13 cases，fair in 7 cases，and poor in 0 case.the excellent-good rate was 93.0%.group b had less time during operation and healing of motion of the elbow joint.conclusion：the excellent or good outcomes of humeral supracondylar fracture in children could be obtained through the treatment with different approach of operation behind elbow joint. group b had better advantages in clinical applications.

【key words】operative approach;children humeral supracondylar fracture;effect

first-author’s address：xinyang hospital of traditional

chinese medicine，xinyang 464000，china

doi：10.3969/j.issn.1674-4985.2012.11.066

肱骨髁上骨折多发于儿童，占小儿肘部骨折的50.75%[1]，保守治疗失败者，常需手术切开复位内固定，而不同手术疗法可能会有不同效果。自2007-2010年，分别选择肘后肱三头肌舌形瓣切断手术入路与肘后肱三头肌剥离手术入路，治疗100例儿童肱骨髁上骨折，取得了满意疗效，两者应用各有优势，现报告如下。

1资料与方法

1.1一般资料2007年1月-2010年1月共手术治疗100例儿童肱骨髁上骨折患者，男73例，女27例，年龄4~12岁，平均7岁。属屈曲型44例，伸直型56例，伸直型又依据gartland分型法，ⅱ型17例，ⅲ型39例；新鲜骨折89例，陈旧骨折11例；其中闭合伤95例，开放伤5例，均为粉碎性骨折。致伤原因多为跌摔伤，合并肱动脉压迫1例，桡神经损伤3例，就诊时间距受伤时间最短约30 min，最长4周，平均1 d。

1.2分组治疗全麻后，患肢上侧卧位，上臂近端置气囊止血带，取肘后正中皮肤切口，切开皮肤、皮下组织并牵开，在尺骨鹰嘴内侧的尺神经沟中将尺神经游离出来，并用橡皮条牵向内侧保护。(1)50例采取肘后肱三头肌舌状瓣切断入路(a组)：显露肱三头肌肌腱及腱膜，做舌形肌瓣切开，舌形瓣尖部在鹰嘴上方约5~10 cm 处，底部位于关节线上并两端扩展到肱骨内、外髁，舌瓣浅部宽，深部窄，向下翻转显露骨折及内外上髁；(2)50例采取肘后肱三头