肘关节镜辅助内侧铰链优先复位联合内固定治疗儿童肱骨外髁SongⅤ型骨折的疗效

Arthroscopic assisted medial hinge reduction and fixation of lateral condylar fractures of humerus(Song typeⅤ)in children

目的观察肘关节镜辅助内侧铰链优先复位联合内固定治疗儿童肱骨外髁SongⅤ型骨折的疗效。方法回顾性分析自2020-04—2021-12采用肘关节镜辅助内侧铰链优先复位联合内固定治疗的20例儿童肱骨外髁SongⅤ型骨折。将关节镜置入关节腔并充盈关节腔,观察骨折线方向,寻找内侧铰链位置后再将前臂旋后,极度伸腕伸指,通过操作入路将探针辅助骨折块复位,复位后可见骨折块与内侧铰链处仍存在较大缝隙,此时减少水压,推挤复位,将1枚直径1.5 mm的克氏针固定于内侧铰链处,关节镜下可见骨折面复位良好,但是仍存在微小缝隙,再继续置入1枚空心钉固定加压骨折块,收紧缝隙。结果20例均获门诊复查或电话随访,随访时间13~30个月,平均16.3个月。切口长度5~8 mm,平均5.9 mm;术中出血量1~5 mL,平均2.8 mL;手术时间40~230 min,平均128 min,住院时间2~6 d,平均3.8 d;内固定去除时间26~114 d,平均69.3 d。患儿术后肘关节活动均得到完全恢复,末次随访肘关节活动度均无异常。Dhillon肘关节功能评分:优20例,优良率100%。无骨折延迟愈合及不愈合,无肘内翻、肘外翻,无神经并发症,无骨化性肌炎以及感染等并发症。结论采用关节镜下辅助复位联合克氏针结合空心钉内固定治疗肱骨外髁SongⅤ型骨折,疗效满意,具有微创、解剖复位、内固定可靠、术后关节功能好、并发症少等特点,该技术值得在临床中推广应用。

Objective To evaluate the effect of arthroscopic assisted reduction and internal fixation for the treatment of Song typeⅤexternal condylar fractures of humerus in children.Methods The data of 20 cases of Song typeⅤhumeral lateral condyle fractures treated with arthroscopic reduction and internal fixation from April 2020 to December 2021 were analyzed retrospectively.There were 13 males and 7 females.The mean age of injury was 4.7 years(1-9 years).The length of incision,the days of hospitalization,the amount of bleeding during operation,the length of operation,the imaging results,the elbow function score at the last follow-up and the postoperative complications were recorded.Results All patients were followed up for an average of 16.3 months(13-30 months),with an average incision length of 5.9 cm(5-8 cm),an average hospital stay of 3.8 days(2-6 days),and an average intraoperative blood loss of 2.8 ml(1-5 mL).The mean operative time was 128 minutes(40-230 minutes),and the mean fixation removal time was 69.3 days(26-114 days).The average time of fracture healing was 6.1 weeks(4-8weeks).Dhillon evaluation of elbow function score:excellent in 20 cases,the excellent and good rate 100%.There were no delayed union,nonunion,cubitus varus,cubitus valgus,nerve complication,myositis ossificans and infection.Conclusion Arthroscopic reduction combined with internal fixation with Kirschner wire and cannulated screw for the treatment of SongⅤfractures of the lateral condyle of humerus,it has the characteristics of minimal invasion,anatomic reduction,reliable internal fixation,good postoperative joint function and less complications,and is worthy of wide clinical application.