超声和关节造影辅助下治疗儿童肱骨远端骨骺分离的临床疗效分析

Comparison of ultrasound versus arthrography guided closed reduction and percutaneous pinning for transphyseal fracture of distal humerus

目的比较超声与关节造影辅助下闭合复位经皮内固定术治疗儿童肱骨远端骨骺分离的临床疗效。方法收集2013年4月至2017年8月收治于华中科技大学同济医学院附属武汉儿童医院骨科的30例肱骨远端骨骺分离的患儿的相关资料。其中,男25例,女5例;平均年龄为20.7个月,年龄范围为10~38个月;患侧为左侧10例,右侧20例。将12例采用关节造影辅助闭合复位经皮内固定术的患儿作为Ⅰ组,将18例采用超声辅助闭合复位经皮内固定术的患儿作为Ⅱ组。比较两组患儿的一般资料和肘关节功能。末次随访采用Flynn肘关节功能评定肘关节功能,按提携角减小角度进行外形评分,包括:①优,提携角减少范围为0°~5°;②良,提携角减小范围为6°~10°;③可,提携角减小范围为11°~15°;④差,提携角减小程度>15°。按屈伸功能减小的程度进行功能评分,包括:①优,屈伸功能减小范围为0°~5°;②良,屈伸功能减小范围为6°~10°;③可,屈伸功能减小范围为11°~15°;④差,屈伸功能减小>15°。结果两组患儿在性别、年龄、患侧、术前受伤时间等方面的差异无统计学意义(P>0.05)。两组患儿在术中透视次数和手术时间上相比,差异具有统计学意义(P<0.05)。所有患儿均行闭合复位经皮内固定术,均获得随访,平均随访时间为28个月,随访时间范围为19~56个月。两组患儿在关节活动范围及Flynn功能评分上的差异均无统计学意义。Ⅰ组术后提携角平均减少5.0°,Ⅱ组术后提携角平均减少2.2°,两组之间的差异无统计学意义。Ⅰ组有2例发生针移位,Ⅱ组有1例发生针移位,两组之间的差异无统计学意义。Ⅰ组有2例肘内翻,Ⅱ组有1例肘内翻,两组之间的差异无统计学意义。两组术后均无骨折不愈合、针道感染等并发症发生。结论运用超声与关节造影辅助闭合复位经皮内固定术治疗儿童肱骨远端骨骺分离均可获得确切的疗效,并发症低且关节功能良好的恢复。超声辅助闭合复位经皮内固定术具有缩短手术时间和减少术中透视次数的优势。

Objective To explore the clinical application of treating transphyseal fracture of distal humerus with closed reduction and percutaneous pinning under ultrasound/arthrography guidance in children.Methods From April 2013 to August 2017,the relevant clinical data were collected from 30 children hospitalized with distal humeral epiphyseal separation.There were 25 boys and 5 girls with a mean age of 20.7(10-38)months.The involved side was left(n=10)and right(n=20).Twelve children undergoing arthrography-assisted closed reduction and internal fixation were selected as groupⅠwhile another 18 undergoing ultrasound-assisted closed reduction and internal fixation as groupⅡ.General profiles and elbow joint function were compared between two groups.Flynn's elbow function was employed for evaluating elbow function during follow-ups and appearance was scored according to the angle of carrying angle reduction.The outcomes were excellent(range of carrying angle reduction 0°~5°),decent(range of carrying angle reduction 6°~10°),fair(range of carrying angle reduction 11°~15°)and poor(degree of carrying angle reduction>15°).Based upon the degree of flexion and extension function reduction,function was judged as excellent(flexion and extension function reduction range of 0°~5°),decent(flexion and extension function reduction range of 6°~10°),fair(flexion and extension function reduction range of 11°~15°)and poor(flexion and extension function reduction>15°).Results No significant inter-group differences existed in gender,age or preoperative injury time(P>0.05).The inter-group differences in frequency of intraoperative fluoroscopy and operative duration had statistical significance(P<0.05).The average follow-up period was 28(19-56)months.No significant inter-group difference existed in joint range-of-motion or Flynn function score.The average reduction angle of postoperative carrying angle was 5.0°in groupⅡand 2.2°in groupⅡ.There was no significant inter-group difference.Needle displacement(n=2,groupⅠ;n=1,groupⅡ)and cubitus varus(n=2,groupⅠ;n=1,groupⅡ)occurred.There was no significant inter-group difference.Neither groups had such postoperative complications as nonunion or pin tract infection.Conclusions Both ultrasound and arthrography assisted closed reduction and internal fixation in the treatment of distal humerus epiphysiolysis may achieve definite efficacy with low complications and an excellent recovery of joint function in children.Ultrasound-assisted closed reduction and internal fixation offers the advantages of shortening operative duration and reducing the frequency of intraoperative fluoroscopy.