臨床整形外科58巻8号

2023年08月発行

特集 小児の上肢をいかに診るか—よくわかる，先天性障害・外傷の診察と治療の進め方

小児肘周辺外傷に対する急性期の対処方法

著者： 小林由香¹ 齋藤育雄²

所属機関： ¹東海大学医学部付属八王子病院整形外科 ²伊勢原協同病院整形外科

ページ範囲：P.997 - P.1004

小児の肘関節周辺骨折の中で最も頻度が高いのは，上腕骨顆上骨折である．急性期に注意すべきポイントは，神経血管損傷とコンパートメント症候群である．Pulseless pink hand(PPH)は，橈骨動脈の拍動が消失しても上腕深動脈や上尺側側副動脈の側副血行路により手指の色調が保たれている状態である．このとき手術で上腕動脈を確認する必要性については，コンセンサスは得られていない．筆者は，観血的整復固定と同時に神経血管を確認している．コンパートメント症候群は頻度が低いが，前腕骨折や高エネルギー外傷を合併しているときには特に注意が必要である．

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