经皮克氏针外侧固定与内外侧交叉固定治疗儿童肱骨髁上骨折的疗效比较

Comparison of clinical effects between simple lateral and internal and external crossed Kirschner wire percutaneous fixation in treatment of humeral supracondylar fractures in children

目的比较闭合复位经皮克氏针外侧固定与内外侧交叉固定治疗儿童肱骨髁上骨折的临床疗效。方法纳入自2013-08—2017-08诊治的116例儿童肱骨髁上骨折,包括15例移位明显或非手术治疗效果不满意的Gartland Ⅱ型骨折,以及101例Gartland Ⅲ型肱骨髁上骨折。47例行闭合复位经皮克氏针外侧固定治疗(A组),69例行闭合复位经皮克氏针内外侧交叉固定治疗(B组)。结果 A组47例获得随访,B组69例获得随访,随访时间平均8(3～12)个月。与A组比较,B组术后6个月肘关节功能Flynn评分更优,末次随访时Baumann角、肱前线恢复情况更满意,差异有统计学意义(P<0.05)。但A组与B组术后1个月肘关节功能Flynn评分、末次随访时肱骨前倾角比较差异无统计学意义(P>0.05)。B组3例术后即刻出现尺神经损伤,拔除内侧1枚克氏针后神经症状逐渐缓解。结论采用闭合复位经皮克氏针固定治疗儿童Gartland Ⅲ型肱骨髁上骨折时,内外侧交叉穿针固定的治疗效果明显优于单纯外侧克氏针固定,尽管可能存在内侧克氏针损伤尺神经的风险,但是仍可通过提高手术技术来避免或后期拔除尽早内侧克氏针来缓解症状。

Objective To compare the clinical results of simple lateral and internal and external crossed Kirschner wire percutaneous fixation for treatment of children with humeral supracondylar fracture. Methods A total of 116 children with humeral supracondylar fractures from August 2013 to August 2017 were included, including 15 Gartland type Ⅲ fractures with disorientation or non -surgical treatment, and 101 cases of Gartland type Ⅲ supracondylar fractures of the humerus. Forty -seven patients underwent closed reduction and percutaneous lateral pining fixation (group A) while 69 patients underwent closed reduction and percutaneous cross pining fixation (group B). Results Forty-seven patients in group A were followed up, and 69 patients in group B were followed up for an average of 8 (3 to 12) months. Compared with group A, the Flynn score of the elbow joint function was better in group B at 6 months after operation. The Baumann angle and anterior line recovery were more satisfactory at the last follow-up, the difference was statistically significant (P <0.05). However, there was no significant difference in the sacral anteversion angle between two group at 1 month after operation, and the humeral anteversion angle at the last follow -up (P〉0.05). In group B, 3 cases of ulnar nerve injury occurred immediately after operation. After removing the inner Kirschner wire, the neurological symptoms gradually relieved. Conclusion Regarding closed reduction and percutaneous K -wire fixation for the treatment of Gartland Ⅲ type humeral supracondylar fractures in children, cross pining fixation is significantly better than the lateral pinning fixation. Although there may be the risk of ulnar nerve injury by internal pin, symptoms can still be alleviated by improving surgical techniques to avoid or removal of the inner medial K-wire later.