外固定架联合克氏针固定治疗儿童倾斜型和粉碎型肱骨远端干-骺交界区骨折

Application of external fixator combined with Kirschner wire fixation for oblique and comminuted distal humeral metaphyseal-diaphyseal junction fractures in children

目的探讨外固定架联合克氏针固定治疗儿童倾斜型和粉碎型肱骨远端干-骺交界区(distal humeral metaphyseal-diaphyseal junction,DHMDJ)骨折的疗效。方法回顾性分析2021年4月—2023年12月收治且符合选择标准的22例儿童DHMDJ骨折临床资料,均行外固定架联合克氏针固定治疗。其中男14例,女8例;年龄1.5~12.0岁,平均6.8岁。受伤至手术时间14~38 h,平均24.2 h。骨折类型:粉碎型18例,倾斜型4例。术前合并正中神经损伤1例、桡神经损伤1例。记录术后并发症发生情况;末次随访时,采用Mayo评分标准评估患侧肘关节功能,测量健、患侧肘关节活动度并基于X线片测量健、患侧鲍曼角、髁干角,比较健患侧差异。结果术中骨折均闭合复位成功,手术顺利完成,无神经损伤等并发症发生。术后4例发生浅表感染,对症处理后愈合;其余切口均Ⅰ期愈合。患儿均获随访,随访时间9~24个月,平均13.8个月。末次随访时,肘关节功能根据Mayo标准获优15例、良6例、可1例,优良率95.5%。术前合并神经损伤者均逐渐自行恢复。X线片复查示骨折均愈合,愈合时间29~61 d,平均35.6 d;末次随访时,健、患侧鲍曼角和髁干角差异均无统计学意义(P>0.05)。随访期间1例出现轻度肘内翻畸形,其余患儿均无严重并发症发生。结论对于儿童倾斜型和粉碎型DHMDJ骨折,采用外固定架联合克氏针固定具有创伤小、操作简便,骨折易于复位且复位后稳定性好,严重并发症发生率低、术后功能恢复好等优势。

Objective To analyze the effectiveness of external fixator combined with Kirschner wire(EF-KW)fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction(DHMDJ)fractures in children.Methods A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed.All patients were treated with EF-KW fixation.There were 14 boys and 8 girls with an average age of 6.8 years(range,1.5-12.0 years).The time from injury to operation was 14-38 hours(mean,24.2 hours).There were 18 cases of comminuted fractures and 4 cases of oblique fractures;and 1 case of median nerve injury and 1 case of radial nerve injury before operation.The occurrence of postoperative complications was recorded.At last follow-up,the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score,and the Baumann’s angle(BA)and humero-capitellar angle(HCA)of the affected and healthy sides were recorded and compared.Results All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred.Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment.The incisions of other patients healed by first intention.All patients were followed up 9-24 months(mean,13.8 months).At last follow-up,according to the Mayo elbow joint function score,the elbow joint function was rated as excellent in 15 cases,good in 6 cases,and fair in 1 case,with an excellent and good rate of 95.5%.The neurologic injury before operation recovered gradually.X-ray films reexamination showed that all fractures healed,and the healing time of fractures ranged from 29 to 61 days,with an average of 35.6 days.At last follow-up,there was no significant difference in BA and HCA between the healthy side and the affected side(P>0.05).During follow-up,1 case developed mild cubitus varus,while the other patients had no serious complications.Conclusion EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma,simple operation,easy reduction,good stability after reduction,low incidence of serious complications,and good elbow functional recovery.