撬拨技术辅助闭合复位穿针内固定治疗复位失败的儿童肱骨髁上骨折

Clinical observation of prying technique assisted close reduction with percutaneous pinning and internal fixation in the treatment of initial reduction failed humeral supracondylar fractures in children

目的探讨撬拨技术辅助闭合复位穿针内固定治疗复位失败的儿童伸直型肱骨髁上骨折的手术技巧。方法自2018年1月至2020年12月我们采用撬拨技术辅助闭合复位穿针内固定治疗21例复位失败的儿童伸直型肱骨髁上骨折,其中Gartland Ⅲ型7例,Ⅳ型14例。手术在肘关节造影C臂机透视下进行,初始复位失败后行经皮撬拨技术辅助闭合复位穿针内固定。术后分别测量Baumann角、侧位肱头角评价复位质量,Flynn评分评价肘关节功能。结果本组患儿的手术时间为25~45 min,平均36 min;骨折愈合时间为3~8周,平均4.2周。术后随访时间为6~22个月,平均11个月。术后无感染、医源性神经损伤、肘内翻等并发症发生。末次随访肘关节功能Flynn评分:优18例,良2例,可1例,优良率95.24%。结论克氏针撬拨技术是儿童骨折复位过程中的一种常用技术,对初始复位失败的肱骨髁上骨折采用该技术治疗,通过杠杆原理可以有效复位移位的骨折,操作安全、简单。

Objective To explore the surgical technique of prying technique assisted close reduction with percutaneous pinning and internal fixation in the treatment of initial reduction failed extension-type humeral supracondylar fractures in children.Methods From January 2018 to December 2020,21 children with initial reduction failed extension-type humeral supracondylar fractures were treated by prying technique assisted close reduction with percutaneous pinning and internal fixation.There were 7 cases of Gartland typeⅢand 14 cases of typeⅣ.The operation was performed under the C-arm X-ray fluoroscopy of elbow arthrography.After the initial reduction failed,prying technique assisted close reduction with percutaneous pinning and internal fixation was conducted.The Baumann angle and lateral humeral head angle were measured to evaluate the quality of reduction,and the Flynn score to evaluate the function of elbow joint.Results The operation time was 25 to 45 minutes,with an average of 36 minutes.The fracture healing time was 3 to 8 weeks,with an average of 4.2 weeks.The follow-up time ranged from 6 to 22 months,with an average of 11 months.There were no postoperative complications such as infection,iatrogenic nerve injury and cubitus varus.The Flynn score of elbow function in the last follow-up was excellent in 18 cases,good in 2 cases and fair in 1 case.The excellent and good rate was 95.24%.Conclusion The Kirschner wire prying technique is a common technique in the process of fracture reduction in children.This technique is used for the treatment of humeral supracondylar fractures with initial reduction failure.The displaced fractures can be effectively reduced through the lever principle,and the operation is safe and simple.