超声引导闭合复位克氏针内固定治疗儿童KilfoyleⅡ、Ⅲ型肱骨内髁骨折

Ultrasound-guided closed reduction and kirschner wires internal fixation for the treatment of KilfoyleⅡandⅢmedial condylar fracture of humerus in children

目的:探讨超声引导闭合复位克氏针内固定治疗儿童KilfoyleⅡ、Ⅲ型肱骨内髁骨折的临床疗效。方法:回顾性分析自2014年1月至2019年8月采用超声引导闭合复位克氏针内固定治疗的32例儿童肱骨内髁骨折的临床资料,其中男23例,女9例;年龄3.2~12.8(8.3±2.1)岁;按照Kilfoyle分型,Ⅱ型12例,Ⅲ型20例;合并肘关节脱位有5例;受伤至手术时间1~5(3.1±1.3)d。术后进行放射性学评估并观察并发症情况,末次随访时采用Mayo肘关节功能评分量表(Mayo elbow per-formance score,MEPS)对肘关节功能进行评估;测量并比较患侧与健侧肱骨-尺骨角。结果:所有患儿获得随访,时间8~26(19.3±5.5)个月。术后骨折均愈合,骨折愈合时间4~6(4.5±0.5)周。无感染、血管神经损伤、骨不连、滑车坏死以及肘内、外翻畸形等并发症发生。患侧肱骨-尺骨角(9.5±3.6)°与健侧(9.1±3.5)°比较差异无统计学意义(P>0.05);患侧MEPS(95.3±2.5)分与健侧(96.3±2.2)分比较差异无统计学意义(P>0.05)。按照Mayo评分标准,所有患儿肘关节功能评定为优。结论:超声引导闭合复位克氏针内固定治疗儿童KilfoyleⅡ、Ⅲ型肱骨内髁骨折是一种安全、有效的方法,值得进一步在临床上推广。

Objective:To explore clinical effectiveness and safety of ultrasound-guided closed reduction and K-wires internal fixation in treating of KilfoyleⅡandⅢmedial condylar fracture of humerus in children.Methods:Clinical data of 32 children with medial condylar fracture of humerus treated with closed reduction and internal fixation with K-wires under the guidance of ultrasound were retrospectively analyzed from January 2014 to August 2019,including 23 males and 9 females,age ranged from 3.2 to 12.8 years old with an average of(8.3±2.1)years old;According to classification of Kilfoyle,12 patients classified to typeⅡand 20 patients were typeⅢ;5 patients combined with elbow dislocation;the time from injury to operation ranged from 1 to 5 days with an average of(3.1±1.3)days.Radiological evaluation of treatment results and complications were observed.At the final follow-up,Mayo elbow performance score(MEPS)was used to evaluate elbow function.And humerus-ulna angle on the affect side and healthy side were measured and compared.Results:All patients were followed up from 8 to 26 months with an average of(19.3±5.5)months.All fractures were healed well,the healing time ranged from 4 to 6 weeks with an average of(4.5±0.5)weeks.No infection,vascular and nerve injury,bone nonunion,trochlear necrosis,cubitus varus or valgus deformity were occurred.According to Mayo scoring,all patients were assessed as excellent.There was no significant difference in angle of humerus-ulna between affected side(9.5±3.6)°and healthy side(9.1±3.5)°,and no difference in MEPS scores between affected side(95.3±2.5)and healthy side(96.3±2.2)(P>0.05).Conclusion:For Kilfoyle typeⅡandⅢmedial condylar fracture of humerus in children,closed reduction and internal fixation with K-wire under ultrasound guidance is a safe and effective method,and could promote in further.