经皮克氏针固定儿童肱骨髁上骨折术中外侧进针点的定位方法研究

Determination of lateral needle insertion point in percutaneous Kirschner wire fixation for pediatric supracondylar fractures of humerus

目的探讨一种经皮肤标志定位外侧进针点（交点法）的方法在儿童肱骨髁上骨折闭合复位克氏针固定术中的应用效果。方法回顾性分析2012年5月至2014年6月应用闭合复位经皮穿针固定治疗的125例肱骨髁上骨折的患儿资料，其中60例未用交点法定位（A组），男46例，女14例；平均年龄（6．3±0．6）岁。骨折根据Gartland分型：Ⅱ型28例，Ⅲ型32例。65例经皮肤标志定位外侧进针点（交点法）行肱骨髁上骨折闭合复位经皮克氏针固定（B组），男50例，女15例；平均年龄（6．4±0．9）岁。骨折根据Gartland分型：Ⅱ型29例，Ⅲ型36例。记录并比较两组患儿的手术时间、住院时间等。末次随访时按Flynn标准评定疗效。两组患者术前一般资料比较差异无统计学意义（P〉0．05），具有可比性。结果125例患儿均闭合复位穿针固定成功，术后获12～15个月（平均13个月）随访。A组患儿的手术时间【（23．1±15．3）min】和透视次数[（9．2±1．0）次】均多于B组[（17．5±10．3）min、（5．3±1．3）次]，差异均有统计学意义（P〈0．05）。末次随访时按Flynn标准评定疗效：A组、B组优良率分别为98．3％（59／60）、98．5％（64／65），差异无统计学意义（P〉0．05）。A组有2例患儿出现针尾刺激症状，有1例出现克氏针滑移。B组中有1例患儿出现张力性水泡。结论交点法是作为闭合复位克氏针固定儿童髁上骨折术中外侧进针点确定的方法，效果可靠、操作简便、可明显减少医患的射线暴露量。

Objective To report our method to determine lateral needle insertion point （intersection point skin marker） in closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus. Methods From May 2012 to June 2014, 125 children with supracondylar fracture of humerus were treated with closed reduction and percutaneous Kirschner wire fixation. Of them, 60 did not use the intersection point method to determine the lateral needle insertion point （group A）, including 46 boys and 14 girls, with an average age of 6.3 ＋ 0.6 years. According to Gartland classification, 28 cases were type 1I and 32 cases type m. In the other 65 children, the intersection point method was used to determine the lateral needle insertion point （group B）, including 50 boys and 15 girls, with an average age of 6.4 ±0.9 years. According to Gartland classification, 29 cases were type Ⅱ and 36 cases type Ⅲ. The 2 groups were compared in terms of operation time, fluoroscopy times, hospital stay and hospitalization cost. The efficacy was evaluated at the final follow-ups using Flynn criteria. The 2 groups were compatible without significant dif- ferences in preoperative general data （ P 〉 0.05） . Results All the 125 children obtained successful closed reduction and percutaneous pin fixation, and an average follow-up of 13 months （from 12 to 15 months） as well. There were significant differences between groups A and B in average operation time （23. 1 ± 15.3 min versus 17.5 ± 10. 3 min） and fluoroscopy times （9.2 ± 1.0 times versus 5.3 ± 1.3 times） （ P 〈 0.05）. There was no statistically significant difference between the 2 groups either in Flynn excellent to good rate [（98.3% （59/60） versus 98.5% （64/65） ] （P 〉 0. 05） . Needle irritation occurred in 2 cases and Kirschner wire shift in one in group A while tensile blistering occurred in one in group B. Conclusion In closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus, the intersection point skin marker is a simple and reliable method to determine the lateral needle insertion point, leading to considerable reduction in radiographic exposure for both patients and doctors.