超声引导下Joystick技术联合克氏针、外支架固定治疗儿童难复Salter-Harris Ⅱ型肱骨近端骨折

Ultrasound guided Joystick technique combined with Kirschner wire and external stent fixation for the treatment of refractory Salter-Harris Ⅱ proximal humeral fractures in children

目的探讨超声引导下Joystick技术联合克氏针、外支架固定治疗儿童难复性Salter-Harris Ⅱ型肱骨近端骨折的临床疗效.方法我院自2018年1月至2022年3月收治手法闭合复位失败的Salter-Harris Ⅱ型肱骨近端骨折患儿9例,均采用超声引导下Joystick技术闭合复位联合克氏针、外固定架固定.全程使用超声进行监控,术前明确骨折情况,肱骨远端打入外支架螺钉作为操作杆、结合直径3.0 mm克氏针术中超声引导撬拨复位并维持位置、克氏针固定后安装组合外固定架,固定完成后再次进行超声检查骨折复位质量,并行C臂机透视验证复位状态.结果手术均顺利完成,闭合复位成功率100%,术后无神经血管损伤、骨折畸形愈合、不愈合、肱骨近端骨骺骨桥形成等并发症,2例患儿近端外支架螺钉钉道红肿,经换药后好转.所有患儿均获得随访,时间6~18个月,平均10.6个月.骨折愈合时间6~8周,平均6.3周.末次随访患儿肩关节Neer评分为90~100分,平均96.3分.结论超声引导下Joystick技术治疗儿童难复性Salter-Harris Ⅱ型肱骨近端骨折可以提高骨折闭合复位成功率、减少术中辐射;克氏针结合外支架固定能提供较好的稳定性,利于患儿早期康复锻炼,符合骨折ERAS理念,值得临床推广.

Objective To explore the clinical efficacy of ultrasound-guided Joystick technique combined with Kirschner wire and external stent fixation in the treatment of refractory Salter-HarrisⅡproximal humeral fractures in children.Methods From January 2018 to March 2022,9 children with Salter-Harris Ⅱ proximal humeral fractures were treated in our hospital with failed manual closed reduction.All cases were treated with ultrasound guided Joystick technique for closed reduction combined with Kirschner wire and external fixation.Ultrasound was used throughout the entire process for monitoring,and the fracture situation was confirmed before surgery.An external stent screw was inserted into the distal humerus as the operating rod,combined with a 3.0 mm diameter Kirschner wire.Ultrasound guidance was used during the surgery to pry and maintain the position.After Kirschner wire fixation,a combined external fixation frame was installed.After fixation,ultrasound was performed again to check the quality of fracture reduction,and the reduction status was verified through C-arm fluoroscopy.Results The surgery was successfully completed,with a 100%success rate in closed reduction.There were no complications such as nerve and blood vessel injury,fracture malunion,nonunion,and proximal humeral epiphyseal bridge formation after surgery.Two cases of children had redness and swelling in the proximal external stent screw path,which improved after dressing change.All patients were follow-up for 6 to 18 months,with an average of 10.6 months.The fracture healing time was 6 to 8 weeks,with an average of 6.3 weeks.The Neer score of the shoulder joint in the last follow-up was 90 to 100 points,with an average score of 96.3 points.Conclusion Ultrasound guided Joystick technique can improve the success rate of closed reduction and reduce intraoperative radiation in the treatment of refractory Salter-Harris Ⅱ proximal humeral fractures in children.The combination of Kirschner wire and external stent fixation can provide good stability,facilitate early rehabilitation and exercise of children,conform to the fracture ERAS concept,and is worthy of clinical promotion.