拇指拨挡技术在儿童Gartland Ⅲ型肱骨髁上骨折尺侧穿克氏针中的应用

Application of thumb blocking technique with ulnar Kirschner wire threading for Gartland type Ⅲ supracondylar humerus fractures in children

目的 探讨采用闭合复位、拇指拨挡技术尺侧穿克氏针治疗儿童Gartland Ⅲ型肱骨髁上骨折的疗效。方法 回顾性分析2020年1月-2021年5月采用闭合复位、拇指拨挡技术尺侧穿克氏针内固定治疗的58例Gartland Ⅲ型肱骨髁上骨折患儿临床资料。男31例,女27例;年龄2~14岁,平均6.4岁。致伤原因:摔伤47例,运动伤11例。受伤至手术时间为24.4~70.6 h,平均49.6 h。术中观察尺侧穿克氏针时环、小指抽动情况,术后观察尺神经损伤情况,记录骨折愈合时间,末次随访时采用Flynn肘关节评分评定疗效,并观察并发症发生情况。结果 术中尺侧穿克氏针时均未出现环、小指抽动,患儿尺神经均无损伤。58例患儿均获随访,随访时间6~24个月,平均12.9个月。1例患儿术后出现术区感染,局部皮肤红肿,克氏针针眼处脓性分泌物渗出,予以门诊静脉输液抗炎、定期换药后好转,骨折初步愈合后拔除克氏针;2例患儿出现克氏针针尾激惹,经口服抗生素,门诊换药治疗后康复。患儿均未出现骨折不愈合、畸形愈合等严重并发症;骨折愈合时间4~6周,平均4.2周。末次随访时Flynn肘关节评分评定疗效,达优52例、良4例、可2例,优良率96.6%。结论 采用闭合复位、拇指拨挡技术尺侧穿克氏针治疗儿童Gartland Ⅲ型肱骨髁上骨折安全且固定稳定,不会造成医源性尺神经损伤。

Objective To explore the effectiveness of thumb blocking technique through closed reduction of ulnar Kirschner wire threading in the treatment of Gartland type Ⅲ supracondylar humerus fractures in children.Methods The clinical data of 58 children with Gartland type Ⅲ supracondylar humerus fractures treated with closed reduction of ulnar Kirschner wire threading by thumb blocking technique between January 2020 and May 2021 were retrospectively analyzed. There were 31 males and 27 females with an average age of 6.4 years ranging from 2 to 14 years.The causes of injury were falling in 47 cases and sports injury in 11 cases. The time from injury to operation ranged from24.4 to 70.6 hours, with an average of 49.6 hours. The twitch of ring and little fingers was observed during operation, the injury of ulnar nerve was observed after operation, and the healing time of fracture was recorded. At last follow-up, the effectiveness was evaluated by Flynn elbow score, and the complications were observed. Results There was no twitch of the ring and little fingers when the Kirschner wire was inserted on the ulnar side during operation, and the ulnar nerve was not injured. All children were followed up 6-24 months, with an average of 12.9 months. One child had postoperative infection in the operation area, local skin redness and swelling, and purulent secretion exudation at the eye of the Kirschner wire, which was improved after intravenous infusion and regular dressing change in the outpatient department,and the Kirschner wire was removed after the initial healing of the fracture;2 children had irritation at the end of the Kirchner wire, and recovered after oral antibiotics and dressing change in the outpatient department. There was no serious complication such as nonunion and malunion, and the fracture healing time ranged from 4 to 6 weeks, with an average of 4.2 weeks. At last follow-up, the effectiveness was evaluated by Flynn elbow score, which was excellent in 52 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 96.6%. Conclusion The treatment of Gartland type Ⅲ supracondylar humerus fractures in children by closed reduction and ulnar Kirschner wire fixation assisted with thumb blocking technique is safe and stable, and will not cause iatrogenic ulnar nerve injury.