超声在闭合复位内外侧交叉穿针固定治疗儿童肱骨髁上骨折中保护尺神经的可行性研究

Feasibility study of protecting ulnar nerve by ultrasound in treating children with supracondylar fracture of humerus by closed reduction and intercross needle fixation

目的:探讨超声在闭合复位内外侧交叉穿针固定治疗儿童肱骨髁上骨折中保护尺神经的可行性。方法:自2018年1月至2019年12月收治63例肱骨髁上骨折患儿,根据引导方式不同分为超声引导组和X线引导组。超声引导组32例,采用超声引导下闭合复位经皮内外交叉克氏针固定,男20例,女12例,年龄3~11(6.06±2.02)岁。X线引导组31例,采用X线引导下闭合复位经皮内外交叉克氏针固定,男17例,女14例,年龄2~10(5.61±1.96)岁。记录两组患者的手术时间,接受电透次数,骨折愈合时间,尺神经损伤情况,术后12个月采用Flynn疗效评分评价功能恢复情况。结果:所有患儿获得随访,超声引导组随访时间9~12(11.53±0.76)个月,X线引导组随访时间10~13(11.51±0.72)个月,两组患儿手术时间、随访时间、骨折愈合时间比较,差异无统计学意义(P>0.05)。X线引导组接受电透次数(21.65±5.58)次明显多于超声引导组(3.06±1.24)次(P<0.01)。超声引导组术后未发生医源性尺神经损伤,X线引导组术后2例出现尺神经损伤,两组比较差异无统计学意义(P>0.05)。术后12个月超声引导组Flynn临床功能评定结果优27例,良4例,可1例;X线引导组优23例,良6例,可1例,差1例,两组比较差异无统计学意义(P>0.05)。结论:超声引导与X线引导治疗儿童肱骨髁上骨折在手术时间、骨折愈合方面疗效相当,但超声引导可以在术中清晰地探测到尺神经所在的位置,最大程度避免因尺侧穿针时而导致的医源性尺神经损伤,是一种安全有效的治疗手段。

Objective:To explore feasibility of protecting ulnar nerve by ultrasound in treating children with supracondylar fracture of humerus by closed reduction and intercross needle fixation. Methods:From January 2018 to December 2019,63 children with supracondylar fractures of humerus were divided into two groups(ultrasound group and X-ray group) depend on the different ways of guidance. Therer were 32 children in ultrasound group treated with closed reduction and Kirschner wire fixation guided by ultrasound,including 20 males and 12 females,aged from 3 to 11 years old with an average of(6.06±2.02)years old. There were 31 children in X-ray group treated with closed reduction and Kirschner wire fixation guided by X-ray,including 17 males and 14 females,aged from 2 to 10 years old with an average of(5.61±1.96) years old. Operation time,X-ray times,fracture healing time,ulnar nerve injury and postoperaqtive Flynn clinical function assessment at 1 year between two groups were recorded and compared. Results:All patients were followed up. The follow-up time of ultrasound group ranged from 9 to 12 months with an average of(11.53±0.76) months,and X-ray group ranged from 10 to 13 months with an average of(11.51±0.72) months. There was no significant difference in operation time,follow-up time and fracture healing time between two groups(P>0.05). The number of intraoperative electrodialysis in ultrasound group was(3.06±1.24) times,and that in X-ray group was(21.65±5.58) times,which was significantly higher than that in ultrasound group(P<0.01). No iatrogenic ulnar nerve injury occurred in ultrasound group,and 2 cases of ulnar nerve injury occurred in X-ray group,the incidence of ulnar nerve injury in ultrasound group was lower than that in X-ray group,but the difference was not statistically significant(P>0.05). At 1 year after operation,Flynn clinical function assessment results in ultrasound group was excellent in 27 cases,4 cases good and 1 case fair, in X-ray group 23 cases got excellent result,6 cases good,1 fair and 1 poor,there was no significant difference between two groups(P>0.05). Conclusion:Ultrasound guided and X-ray guided treatment of supracondylar fractures of humerus in children have similar effect of opertaion time and fracture healing,while ultrasound guidance could clearly detected the position of ulnar nerve,and avoid occurrence of iatrogenic ulnar nerve injury caused by ulnar puncture,which is a safe and effective treatment method.