尺骨鹰嘴骨牵引+手法整复治疗小儿肱骨髁上不稳定骨折的临床疗效分析.docVIP

尺骨鹰嘴骨牵引+手法整复治疗小儿肱骨髁上不稳定骨折的临床疗效分析 　　[摘要] 目的 总结尺骨鹰嘴骨牵引+闭合手法整复治疗小儿肱骨髁上不稳定骨折的临床治疗疗效，并探讨其治疗方法。 方法 回顾分析2010年2月―2013年1月期间该院收治的154例小儿肱骨髁上不稳定骨折。骨折按照受伤机制分类：伸直型132例（根据侧方受力的不同分为尺偏型78例，桡偏型54例），屈曲型22例；按照骨折移位移位程度分类（Gartland分型）：GartlandⅡ型97例，GartlandⅢ型35例。合并旋转者26例。所有患者均采用尺骨鹰嘴骨牵引，并配合手法整复治疗，术后第2～5天床旁患侧肘关节正侧位X线片，根据骨折断端移位方向，行三维方向调整牵引重量和角度，并辅以手法整复调整，以达到骨折复位要求。结果 该研究所有患者均获得随访，随访时间随访时间3.0～18.0个月，平均（12.3±3.4）个月，无肘内外翻畸形、神经损伤和Volkmann挛缩等并发症的发生。根据Flynn评价标准结果：优125例，良24例，差5例，优良率：96.8%。 结论 通过尺骨鹰嘴骨牵引，配合手法整复复位，术后在X光床旁监控下，随时调整牵引重量和角度，以此来治疗小儿肱骨髁上移位不稳定骨折，具有方法简单，操作方便，患儿痛苦小、能配合，临床疗效好等优点。 　　[关键词] 肱骨髁上骨折；儿童；尺骨鹰嘴骨牵引；肘关节 　　[中图分类号] R473.73 [文献标识码] A [文章编号] 1674-0742（2015）11（b）-0056-03 　　[Abstract] Objective To summarize the clinical efficacy of ulnar olecranon traction and closed manipulative reduction in the treatment of unstable supracondylar humerus fracture in children and explore its treatment option. Methods A retrospective analysis was conducted on 154 children with unstable supracondylar humerus fracture admitted in our department from February 2010 to January 2013. According to the mechanism of injury， the fractures were classified into extension type （132 patients， including 78 cases with ulnar deviation type and 54 cases with radius deviation type reclassified based on the degree of lateral pressure） and flexion type（22 patients）. According to the degree of displacement fracture（Gartland typing）， there were 97 patients with fracture of Gartland II type and 35 patients with fractures of Gartland III type. 26 patients had distal rotational displacement. All patients were treated with ulnar olecranon traction and manipulation reduction. Positive lateral X-ray film of elbow joint was conducted within 2 to 5 days after surgery. According to the direction of displaced fractures， ulnar olecranon traction was adjusted by the angle and weight in three dimensions supplemented by manipulation reduction to meet the requirements of the fracture. Results All of the patients were followed up for 3.0 to 18.