| 儿童肱骨髁上骨折伴神经血管损伤的治疗 |
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Received:February 17, 2011
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李叔强 |
LI Shu-qiang |
吉林大学第一医院骨关节二科,吉林 长春 130021 |
Department of Orthopaedics,the First Hospital Affiliated to Jilin University,Changchun 130021,Jilin,China |
lishuqiang666@hotmail.com |
| 张宁 |
ZHANG Ning |
吉林大学第一医院骨关节二科,吉林 长春 130021 |
Department of Orthopaedics,the First Hospital Affiliated to Jilin University,Changchun 130021,Jilin,China |
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| 齐欣 |
QI Xin |
吉林大学第一医院骨关节二科,吉林 长春 130021 |
Department of Orthopaedics,the First Hospital Affiliated to Jilin University,Changchun 130021,Jilin,China |
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| 刘建国 |
LIU Jian-guo |
吉林大学第一医院骨关节二科,吉林 长春 130021 |
Department of Orthopaedics,the First Hospital Affiliated to Jilin University,Changchun 130021,Jilin,China |
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| 杨晨 |
YANG Chen |
吉林大学第一医院骨关节二科,吉林 长春 130021 |
Department of Orthopaedics,the First Hospital Affiliated to Jilin University,Changchun 130021,Jilin,China |
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| 李冬松 |
LI Dong-song |
吉林大学第一医院骨关节二科,吉林 长春 130021 |
Department of Orthopaedics,the First Hospital Affiliated to Jilin University,Changchun 130021,Jilin,China |
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| 期刊信息：《中国骨伤》2011年24卷，第8期，第678-680页 |
| DOI：10.3969/j.issn.1003-0034.2011.08.017 |
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目的: 探讨针对伴有神经、血管损伤的儿童肱骨髁上骨折的治疗方法.
方法: 自2002 年2月至2007年11月手术治疗闭合复位不满意的Ⅱ型和Ⅲ型肱骨髁上骨折儿童96例,男59例,女37例；年龄4～16岁,平均6.4 岁.16例手术患儿出现17个神经损伤症状,桡神经损伤5例,正中神经损伤7例,其中1例伴有尺神经损伤,尺神经损伤4例；13例出现肢体远端桡动脉搏动减弱、手凉血管损伤症状.比较患肢术前、术后神经、血管恢复情况,必要时应用肌电图、多普勒超声明确诊断和指导进一步治疗.
结果: 96例患儿85例术后随访6～18个月,平均11个月,73例患儿切口Ⅰ愈合,12例切口Ⅱ期愈合,无感染及肘关节功能障碍.5例桡神经损伤病例中3例桡神经损伤患儿术后3个月桡神经损伤症状完全消失；1例术后3个月行桡神经探查松解术,术后5个月症状消失；1例医源性桡神经损伤解除石膏压迫3个月后神经功能完全恢复.正中神经损伤7例,其中1例伴发尺神经损伤,6例正中神经损伤患儿术后6个月神经功能完全恢复；伴有尺神经损伤的病例Ⅱ期行神经探查,术后9个月神经损伤症状消失.尺神经损伤5例,其中伴发正中神经损伤1例,尺神经损伤病例术后6个月神经症状完全消失.术前出现桡动脉搏动弱、手凉症状13例,术中未行血管探查,骨折固定后桡动脉损伤症状消失.
结论: 肱骨髁上骨折Ⅰ期手术过程中常规探查尺神经、正中神经和桡神经,及血管是否探查根据术前查体决定,肌电图及多普勒超声不作为术前常规检查项目. |
| [关键词]:肱骨骨折 肘关节 血管 |
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| Treatment of humeral supracondylar fracture in children with neurovascular complications |
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Abstract:
Objective: To discuss the treatment methods of humeral supracondylar fracture in children with neurovascular complications.
Methods: Ninety-six children(59 males,37 females) with humeral supracondylar fractures were treated by surgery from February 2002 to November 2007,with the mean age of 6.4 years old(ranged from 4 to 16 years). Seventeen symptoms of nerve damage occurred in 16 cases,including radial nerve injury in 5 cases,median nerve injury in 7 cases,of which 1 cases with ulnar nerve injury,ulnar nerve injury in 5 cases;13 patients had symptoms of vascular injury such as pulse weakness and hands coldness. The patients accompanied by nerve,blood vessel injury symptoms were all treated with open reduction and internal fixation.
Results: Eighty-five patients were followed up with an average duration of 11 months(ranged from 6 to 18 months). Seventy-three patients had incision healing at the first stage and other 12 patients had incision healing at the second stage. All the 85 patients had no complications such as incision infection and functional disturbance of elbow joint. Among 5 patients with radial nerve injury,3 patients had symptoms disappeared completely at 3 months after operation;one patient underwent exploration lysis at 3 months after operation and the symptoms disappeared at 5 months after operation;another 1 patient with iatrogenic injury of radial nerve had nerve function recovered at 3 months after releasing plaster compression. Among 7 patients with median nerve injury,6 patients had nerve function recovered completely at 6 months after operation;another 1 patient combined with ulnar nerve injuries had nerve function recovered at 9 months after exploring of nerve at the second stage. Five patients with ulnar nerve injury had nerve function recovered completely at 6 months after operation. Preoperative symptoms of radial artery pulse weakness and cold hand in 13 patients disappeared after fracture reduction.
Conclusion: The ulnar nerve should be explored during the operation at the first stage of supracondylar fracture. Wether the median nerve,radial nerve and blood vessel be explored or not should be decided by preoperative examination results. The preoperative EMG and Doppler ultrasound examination is not a routine examination before surgery. |
| KEYWORDS:Humeral fractures Elbow joint Blood vessels |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李叔强,张宁,齐欣,刘建国,杨晨,李冬松.儿童肱骨髁上骨折伴神经血管损伤的治疗[J].中国骨伤,2011,24(8):678~680 |
| 英文格式: | LI Shu-qiang,ZHANG Ning,QI Xin,LIU Jian-guo,YANG Chen,LI Dong-song.Treatment of humeral supracondylar fracture in children with neurovascular complications[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(8):678~680 |
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