关节镜直视下闭合复位经皮克氏针固定治疗Jakob Ⅱ度肱骨外髁骨折

Efficacies of arthroscopy by direct visualization closed reduction and percutaneous pinning for Jakob Ⅱ lateral condylar humeral fracture in children

目的探讨关节镜直视下闭合复位经皮克氏针固定治疗Jakob II度儿童肱骨外髁骨折(lateral condylar humeral fracture,LCHF)的方法和临床效果。方法回顾性分析无锡市第九人民医院小儿骨科2019年1月至2021年12月收治的Jakob Ⅱ度肱骨外髁骨折46例患儿的临床资料,其中男30例,女16例,年龄为(6.2±2.1)岁,年龄范围为2~10岁;左侧20例,右侧26例。记录手术时间、骨折愈合时间、并发症发生情况及肘关节活动度,采用Broberg和Morrey评分标准评价肘关节功能。结果所有骨折均为新鲜骨折,骨折至手术时间为(2.7±0.7)d,时间范围是2~4 d。46例患儿受伤机制均为摔伤,其中有3例合并尺骨鹰嘴骨折,2例患儿合并桡骨颈骨折。46例患儿术中采用关节镜直视下成功复位,复位后行经皮交叉克氏针内固定,术中X线显示骨折复位满意。骨折愈合时间为(7.4±0.8)周,时间范围为6~8周;手术时间为(37.6±4.2)min,时间范围为36~45 min。随访时间为(21.5±5.2)个月,时间范围为13~30个月,术后患儿均未出现针道感染、骨折不愈合、延迟愈合、畸形愈合等并发症。末次随访时,患肢肘关节屈曲活动范围与健侧对比角度丢失(3.3±1.1)°,伸直活动范围与健侧对比角度丢失(2.8±0.9)°。根据Broberg和Morrey评分标准评定肘关节功能:优43例,良3例。结论关节镜直视下闭合复位经皮克氏针固定治疗儿童肱骨外侧髁骨折是一种安全有效的术式,可以减少软组织剥离并降低了畸形愈合或缺血性坏死的风险。

Objective To explore the feasibility and clinical efficacy of closed reduction and percutaneous pinning fixation for treating Jakob Ⅱ lateral condylar humeral fractures in children under arthroscopy by direct visualization.Methods From January 2019 to December 2021,retrospective analysis was performed for 46 hospitalized children with Jakob Ⅱ lateral condylar humeral fractures.There were 30 boys and 16 females with an average age of(6.2±2.1)(2-10)years.The involved side was left(n=20)and right(n=26).Operative duration,healing time,complications and elbow motion were recorded.Elbow function was assessed by the scores of Broberg&Morrey.Results All fall fractures were fresh with an average interval from injury to surgery(2.7±0.7)(2-4)days.The fractures involved olecranon(n=3)and radial neck(n=2).All fractures were successfully reduced intraoperatively under arthroscopy by direct visualization.Percutaneous pinning and internal fixation was performed after reduction.Intraoperative radiograph revealed satisfactory reduction.Average healing time was(7.4±0.8)(6-8)week and average operative duration(37.6±4.2)(36-45)min.During an average follow-up period of(21.5±5.2)(13-30),there was no instance of pin tract infection,nonunion,delayed union or malunion.At the final follow-up,range of motion of affected elbow joint was lost in flexion(3.3±1.1)°and in extension(2.8±0.9)°as compared with contralateral side.According to the scale of Broberg&Morrey,elbow functions were excellent(n=43)and decent(n=3).Conclusions Arthroscopic direct reduction and percutaneous fixation are both safe and efficacious for lateral humeral condylar fractures in children.It not only minimizes soft tissue dissection,but also lowers the risks of malunion or avascular necrosis.