伴“无脉手”的儿童肱骨髁上骨折的治疗

于铁强, 左玉明, 王月光, 廉小婧, 李飞, 万广亮, 李晓亮

中国临床解剖学杂志 ›› 2022, Vol. 40 ›› Issue (1) : 85-88.

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中国临床解剖学杂志 ›› 2022, Vol. 40 ›› Issue (1) : 85-88. DOI: 10.13418/j.issn.1001-165x.2022.1.17
临床研究

伴“无脉手”的儿童肱骨髁上骨折的治疗

  • 于铁强, 左玉明, 王月光, 廉小婧, 李飞, 万广亮, 李晓亮
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Treatment of supracondylar fracture of humerus with pulseless hands in children 

  • Yu Tieqiang, ZuoYuming, Wang Yueguang, Lian Xiaojing, Li Fei, Wan Guangliang, Li Xiaoliang
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摘要

目的 总结不能触及桡动脉的儿童肱骨髁上骨折的治疗方法与效果。  方法 回顾2010年1月至2018年6月住院治疗并随访1年以上的肱骨髁上骨折伴“无脉手”的病例45例。其中男孩23例,平均年龄5岁8个月;女孩22例,平均年龄5岁6个月;摔伤37例,乘坐电动车摔伤4例,高空坠落伤3例,交通伤1例。均为Gartland Ⅲ型骨折。予以闭合复位克氏针固定术18例,切开探查血管及骨折复位克氏针固定术27例。多普勒评价动脉搏动及有无血流灌注。术后4周去除石膏及克氏针。  结果    患儿随访12至15个月,平均随访13个月。骨折均在4 ~ 12周骨性愈合。采用Flynn等临床功能评定标准,肘关节功能优42例,良3例。末次随访时桡动脉搏动良好,未出现再移位、针道感染及肘内翻等并发症。  结论    “苍白手”应立刻探查血管,“粉红手”闭合复位克氏针固定术后48 h内应密切观察桡动脉搏动,闭合复位术失败者或术后多普勒检查与术前有异者应切开探查血管、复位骨折并固定。移位大的肱骨髁上骨折闭合复位术后应注意观察桡动脉搏动。

Abstract

Objective To summary the therapeutic method and clinical effect of supracondylar fractures of the humerus with pulseless hand in children. Methods A total of 45 patients of humeral supracondylar fracture with pulseless hands were hospitalized and followed up for more than one year from January 2010 to June 2018.  There were 23 boys, with an average age of 5 years and 8 months. There were 22 girls, with an average age of 5 years and 6 months. There were 36 cases of fall injury, 4 cases of electric vehicle falls, 3 cases of high fall, and 1 case of traffic accident. All cases were Gartland type III fractures. Closed reduction and Kirschner wire fixation were performed in 18 cases, and open exploration of blood vessels and fracture reduction with Kirschner wire fixation in 27 cases. Arterial pulse and the presence or absence of perfusion were evaluated by Doppler. Plaster and Kirschner wire were removed 4 weeks after surgery. Results The children were followed up for 12 to 15 months, with an average follow-up of 13 months. The fractures all healed around 4-12 weeks. According to Flynn evaluation standard of elbow performance score: excellent in 42 cases and good in 3 cases. At the last follow-up, the radial artery pulsation was good, and there were no complications such as redisplacement, pin tract infections and cubitus varus. Conclusions The pale hand should be explored the vessels immediately, and the failed closed reduction.  Radial arterial pulsation should be closely observed within 48 h after closed reduction and Kirschner wire fixation for pink hand.  Blood vessels should be opened for exploration, fracture reduction and fixation for those who failed closed reduction or had differences between preoperative and postoperative Doppler examination. After reduction of the supracondylar fracture of the humerus, attention should be paid to the presence or absence of radial artery pulsation.

关键词

肱骨髁上骨折 /  无脉 /  固定 /  儿童

Key words

Supracondylar humeral fractures /  Pulesless /  Fixation /  Children

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于铁强, 左玉明, 王月光, 廉小婧, 李飞, 万广亮, 李晓亮. 伴“无脉手”的儿童肱骨髁上骨折的治疗[J]. 中国临床解剖学杂志. 2022, 40(1): 85-88 https://doi.org/10.13418/j.issn.1001-165x.2022.1.17
Yu Tieqiang, ZuoYuming, Wang Yueguang, Lian Xiaojing, Li Fei, Wan Guangliang, Li Xiaoliang. Treatment of supracondylar fracture of humerus with pulseless hands in children [J]. Chinese Journal of Clinical Anatomy. 2022, 40(1): 85-88 https://doi.org/10.13418/j.issn.1001-165x.2022.1.17
中图分类号: R726.8   

参考文献

[1]  Harris LR, Arkader A, Broom A, et al. Pulseless supracondylar humerus fracture with anterior interosseous nerve or median nerve injury-an Aabsolute indication for open reduction[J]? J Pediatr Orthop, 2019, 39(1): e1-e7. DOI: 10.1097/BPO.0000000000001238.
[2] Badkoobehi H, Choi PD, Bae DS, et al. Management of the pulseless pediatric supracondylar humeral fracture[J]. J Bone Joint Surg Am, 2015, 97(11): 937-943. DOI: 10.2106/JBJS.N.00983.
[3] Tunku-Naziha TZ, Wan-Yuhana W, Hadizie D, et al. Early vessels exploration of pink pulseless hand in gartland III supracondylar fracture humerus in children: facts and controversies[J]. Malays Orthop J, 2017, 11(1): 12-17. DOI: 10.5704/MOJ.1703.005.
[4]  于铁强, 左玉明, 王月光, 等. 儿童类盖氏骨折的治疗[J]. 中国骨与关节杂志, 2018, (6): 464-467. DOI: 10.3969/j.issn.2095-252X. 2018. 06.013.
[5]  于铁强, 左玉明, 王月光, 等. 儿童浮肘损伤的分型与治疗[J]. 中国骨与关节损伤杂志, 2017, (11): 1212-1213. DOI: 10.7531/j.issn.1672-9935.2017.11.040.
[6]  于铁强, 左玉明, 王月光, 等. 改良外侧交叉克氏针内固定治疗儿童移位肱骨髁上骨折[J]. 中国骨与关节损伤杂志, 2017, (1): 88-89. DOI: 10.7531/j.issn.1672-9935.2017.01.030.
[7]  Louahem D, Cottalorda J. Acute ischemia and pink pulseless hand in 68 of 404 gartland type III supracondylar humeral fractures in children: urgent management and therapeutic consensus[J]. Injury, 2016, 47(4): 848-852. DOI: 10.1016/j.injury.2016.01.010.
[8] Franklin CC, Skaggs DL. Approach to the pediatric supracondylar humeral fracture with neurovascular compromise[J]. Instr Course Lect, 2013, 62: 429-433. PMID: 23395047.
[9] Mangat KS, Martin AG, Bache CE. The 'pulseless pink' hand after supracondylar fracture of the humerus in children: the predictive value of nerve palsy[J]. J Bone Joint Surg Br, 2009, 91(11): 1521-1525. DOI: 10.1302/0301-620X.91B11.22486.
[10]Reigstad O, Thorkildsen R, Grimsgaard C, et al. Supracondylar fractures with circulatory failure after reduction, pinning, and entrapment of the brachial artery: excellent results more than 1 year after open exploration and revascularization[J]. J Orthop Trauma, 2011, 25(1): 26-30. DOI: 10.1097/BOT.0b013e3181db276a.
[11]Özkul E, Gem M, Alemdar C, et al. Vascular injury following supracondylar humerus fractures in children[J]. Ulus Travma Acil Cerrahi Derg, 2016, 22(1): 84-89. DOI: 10.5505/tjtes.2015.83720.
[12]Benedetti VM, Farsetti P, Martinelli O, et al. The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children[J]. Bone Joint J, 2013, 95-B(5): 694-698. DOI: 10.1302/0301-620X.95B5.31042.
[13]Latz D, Grassmann J, Schiffner E, et al. Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report[J]. J Med Case Rep, 2017, 11(1): 69. DOI: 10.1186/s13256-017-1240-4.

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