[1]黄琪钧,崔邦胜△,郭锋.闭合复位联合改良经鹰嘴内侧旁克氏针交叉内固定治疗儿童肱骨髁上骨折的临床分析[J].中国中医骨伤科杂志,2023,31(01):77-80+83.
　HUANG Qijun,CUI Bangsheng,GUO Feng.Clinical Analysis on Closed Reduction Combined with Improved Transolecranon Lateral Kirschner Wire Cross Internal Fixation on the Treatment of Patients with Supracondylar Fractures of the Humerus in Children[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(01):77-80+83.
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闭合复位联合改良经鹰嘴内侧旁克氏针交叉内固定治疗儿童肱骨髁上骨折的临床分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年01期
页码:
77-80+83
栏目:
临床报道
出版日期:
2023-01-15

文章信息/Info

Title:
Clinical Analysis on Closed Reduction Combined with Improved Transolecranon Lateral Kirschner Wire Cross Internal Fixation on the Treatment of Patients with Supracondylar Fractures of the Humerus in Children
文章编号:
1005-0205(2023)01-0077-04
作者:
黄琪钧1; 崔邦胜2△; 郭锋2
1广州中医药大学(广州,510405) 2广州中医药大学顺德医院
Author(s):
HUANG Qijun1; CUI Bangsheng2△; GUO Feng2
1Guangzhou University of Traditional Chinese Medicine,Guangzhou 510405,China; 2Shunde Hospital of Guangzhou University of Traditional Chinese Medicine,Foshan 528300,Guangdong China.
关键词:
肱骨髁上骨折;  尺骨鹰嘴;  闭合复位;  克氏针;  内固定
Keywords:
supracondylar humeral fractures;  ulnar olecranon;  closed reduction;  Kirschner wire;  internal fixation
分类号:
R683.41
文献标志码:
B
摘要:
目的:探讨通过闭合复位联合改良经鹰嘴内侧旁克氏针交叉内固定治疗儿童肱骨髁上骨折的临床疗效。方法:回顾性分析2018年9月至2021年11月诊治的20例儿童肱骨髁上骨折患者,麻醉下行闭合复位后,自肱骨外髁穿进2枚克氏针+鹰嘴内侧旁置入1枚克氏针经皮交叉内固定。根据美国特种外科医院(HSS)评分和影像学分析进行功能评估并评价治疗效果。结果:20例患儿均顺利完成手术,手术时间为(62.1±23.1)min,住院时间为(3.1±1.5)d,骨折全部痊愈,愈合时间为5～9周,平均随访时间为7个月(3～12个月)。术后随访,所有患儿未发生钉道感染、缺血性肢体挛缩综合征等相关并发症,也无肘关节内翻、外翻畸形、内固定克氏针松动断裂、肱骨髁内侧皮质劈裂及异位骨化等情况。末次随访时Baumann角为72.6°±3.2°; 同时根据HSS肘关节功能评价标准进行评分:优17例,良2例,可1例,差0例,最差0例,优良率为95%,评分结果为(91.9±3.9)分。结论:采用闭合复位联合改良经鹰嘴内侧旁克氏针交叉内固定治疗儿童肱骨髁上骨折,操作相对简便安全、稳定性高,而且能够避免损伤尺神经等并发症,值得临床推广应用。
Abstract:
Objective:To explore the clinical efficacy of closed reduction combined with improved transolecranon lateral Kirschner wire cross internal fixation on the treatment of patients with supracondylar fractures of the humerus in children.Methods:A total of 20 children with supracondylar humeral fractures treated from September 2018 to November 2021 were retrospectively analyzed.After closed reduction under anesthesia,patients were treated by percutaneous fixation of 2 Kirschner wires via lateral condyle of humerus and 1 Kirschner wire via paracondyle of medial ulnar olecranon.The Hospital of Specia Surgery(HSS)score and imaging analysis were adopted to evaluate the functional recovery and therapeutic effect.Results:All the 20 cases were successfully operated.The operation time was(62.1±23.1)min,and the hospital stay was(3.1±1.5)d.All patients had their fractures healed,and the fracture healing time was 5 to 9 weeks.Furthermore,they were followed up for 3 to 12 months with 7 months on average.During postoperative follow-up,none of the patients presented pin-tract infections,ischemic convulsion of extremities syndrome and other complications.Meanwhile,they didn't present cubitus varus or valgus deformity,Kirschner wire loosening or breakage,fracture of medial condyle cortex of humerus,ectopic ossification and other conditions.At the last follow-up,the Baumann's angle was 72.6°±3.2°,and the score was made according to the HSS elbow function evaluation criteria.Finally the result was excellent in 17 cases,good in 2 cases,fair in 1 case,poor in 0 case and worst in 0 case.Meanwhile,the excellent and good rate was 95%,and the score was(91.9±3.9)points.Conclusion:It is relatively simple,safe and stable,and can avoid complications such as ulnar nerve injury to use closed reduction combined with improved transolecranon lateral Kirschner wire cross internal fixation on the treatment of patients with supracondylar fractures of the humerus in children,which is worthy of clinical promotion and application.

参考文献/References:

[1] 王敦壮,王晓波.肱骨髁上骨折的治疗进展[J].中国中医骨伤科杂志,2010,18(4):65-66.
[2] ZORRILLA S DE NEIRA J,PRADA-CANIZARES A,MARTI-CIRUELOS R,et al.Supracondylar humeral fractures in children:current concepts for management and prognosis[J]. Int Orthop,2015,39(11):2287-2296.
[3] 方建文.肱骨髁上骨折并发症分析[J].中外医疗,2019,38(27):33-35.
[4] 张殿英,王艳华,王天兵,等.肘关节术后6种不同功能评分标准的比较[J].中华手外科杂志,2008(4):243-246.
[5] 陈元平,刘兰芝.肘内外侧联合切口治疗儿童Gartland Ⅲ型肱骨髁上骨折66例[J].中国中医骨伤科杂志,2015,23(5):56-57.
[6] 白有海,魏有强,宋昌才.肘外侧与内侧入路切开复位内固定术治疗儿童Gartland Ⅲ型伸直肱骨髁上骨折疗效分析[J].中国骨与关节损伤杂志,2020,35(3):305-306.
[7] BRIGHTON B,ABZUG J,HO C A,et al.Current strategies for the management of pediatric supracondylar humerus fractures:tips and techniques for successful closed treatment[J].Instr Course Lect,2016,65:353-360.
[8] SKAGGS D L.Elbow fractures in children:diagnosis and management[J]. J Am Acad Orthop Surg,1997,5(6):303-312.
[9] LADENHAUF H N,SCHAFFERT M,BAUER J.The displaced supracondylar humerus fracture:indications for surgery and surgical options:a 2014 update[J]. Curr Opin Pediatr,2014,26(1):64-69.
[10] VUILLERMIN C,MAY C,KASSER J.Closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures[J].JBJS Essent Surg Tech,2018,8(2):e10.
[11] 莫贤跃,姜权.Gartland Ⅲ型儿童肱骨髁上骨折治疗进展[J].广西中医药大学学报,2015,18(1):71-74.
[12] 孙贤杰,张新根,石钢,等.闭合复位克氏针固定治疗小儿肱骨髁上骨折38例[J].中国中医骨伤科杂志,2019,27(4):44-46.
[13] 周游,刘萌,廖俊城,等.闭合复位经皮交叉克氏针不同置针方式固定治疗严重儿童肱骨髁上骨折的疗效比较[J].中国中医骨伤科杂志,2019,27(9):20-24.
[14] 王国强,刘少华,格日乐,等.闭合复位经皮穿针治疗小儿肱骨髁上骨折[J].临床骨科杂志,2019,22(5):638-640.
[15] LEE S S,MAHAR A T,MIESEN D,et al.Displaced pediatric supracondylar humerus fractures:biomechanical analysis of percutaneous pinning techniques[J]. J Pediatr Orthop,2002,22(4):440-443.
[16] SAHU R L.Percutaneous K-wire fixation in paediatric supracondylar fractures of humerus:a retrospective study[J]. Niger Med J,2013,54(5):329-334.
[17] MEMISOGLU K,CEVDET K C,ATMACA H.Does the technique of lateral cross-wiring(Dorgan's technique)reduce iatrogenic ulnar nerve injury?[J].International Orthopaedics,2011,35(3):375-378.
[18] 詹翼,贝朝涌.儿童肱骨髁上骨折相关的神经损伤研究进展[J].中国临床解剖学杂志,2021,39(1):115-117.
[19] 何晖,张亚忠,黎旭军,等.儿童肱骨髁上骨折克氏针+捆绑带内固定的临床应用[J].中国中医骨伤科杂志,2017,25(1):53-54.

备注/Memo

备注/Memo:
基金项目:佛山市科技局科研项目(2016AB003913)
△通信作者 E-mail:15918089538@139.com
更新日期/Last Update: 2023-01-10