自制克氏针置入瞄准装置在儿童肱骨髁上骨折术中的应用

Application of self-designed guide device for Kirschner-wire placement in surgery for paediatric fractures of supracondylar humerus

目的自制克氏针置入瞄准装置应用于儿童肱骨髁上骨折术中并评价其疗效。方法回顾性分析2019年3月至2023年1月于南京医科大学附属淮安第一医院骨科接受手术治疗的117例伸直型肱骨髁上骨折患儿资料。男64例,女53例;年龄(5.8±1.5)岁;骨折根据Gartland分型:Ⅱ型67例,Ⅲ型50例;受伤至手术时间(48.5±10.8)h。所有患儿根据克氏针瞄准方式的不同分为2组:对照组(采用注射器针头辅助外侧经皮克氏针固定)58例和研究组(采用自制克氏针置入瞄准装置辅助外侧经皮克氏针固定)59例。比较两组患儿手术时间、一次性置针数、术中透视次数、Baumann角、提携角、骨折愈合时间、末次随访时Flynn评分肘关节功能优良率及术后并发症发生率。结果两组患儿术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。117例患儿术后获(15.3±3.2)个月随访。研究组患儿的手术时间[(30.6±4.5)min]、透视次数[(15.6±2.1)次]均显著少于对照组[(40.6±7.3)min、(23.7±4.9)次],而一次性置针率[84.2%(149/177)]显著高于对照组[32.2%(56/174)],差异均有统计学意义(P<0.05)。患儿的提携角、Baumann角、骨折愈合时间和末次随访时Flynn评分肘关节功能优良率两组间比较差异均无统计学意义(P>0.05)。研究组患儿的并发症发生率(6.8%,4/59)显著低于对照组(20.7%,12/58),差异有统计学意义(P<0.05)。结论自制克氏针置入瞄准装置结构简单、使用方便,在儿童肱骨髁上骨折术中可提高一次性置针率,减少术中透视次数,降低并发症发生率。

ObjectiveTo evaluate our self-designed guide device for Kirschner-wire placement in the surgery for paediatric fractures of supracondylar humerus.MethodsA retrospective study was conducted of the 117 children who had been treated for fractures of supracondylar humerus at Department of Orthopedics,The First People's Hospital of Huaian Affiliated to Nanjing Medical University from March 2019 to January 2023.There were 64 boys and 53 girls with an age of(5.8±1.5)years.By the Gartland classification,there were 67 fractures of typeⅡand 50 fractures of typeⅢ.The time from injury to operation averaged(48.5±10.8)hours.The children were divided into 2 groups according to how their Kirschner-wires were placed.In the control group of 58 cases,external percutaneous Kirschner-wire placement was assisted using a syringe needle;in study group of 59 cases,external percutaneous Kirschner-wire placement was assisted using our self-designed guide device for Kirschner-wire placement.The operation time,rate of one-time placement of disposable K-wire,intraoperative fluoroscopy frequency,Baumann angle,carrying angle,fracture healing time,Flynn score of elbow joint function at the final follow-up,and postoperative complications were compared between the 2 groups.ResultsThere was no significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).The 117 pediatric patients were followed up for(15.3±3.2)months after operation.The operation time[(30.6±4.5)min]and intraoperative fluoroscopy frequency[(15.6±2.1)times]in the study group were significantly less than those in the control group[(40.6±7.3)min and(23.7±4.9)times],while the rate of one-time placement of disposable K-wire in the study group was significantly higher than that in the control group[84.2%(149/177)versus 32.2%(56/174)](P<0.05).There were no significant differences in Baumann angle,carrying angle,fracture healing time,or Flynn score of elbow joint function at the final follow-up between the 2 groups(P>0.05).The incidence of complications in the study group(6.8%,4/59)was significantly lower than that in the control group(20.7%,12/58)(P<0.05).ConclusionsOur self-designed guide device for Kirschner-wire placement is simple and convenient to use.In the surgery for paediatric fractures of supracondylar humerus,it can improve the rate of one-time placement of disposable K-wire,reduce intraoperative fluoroscopy,and decrease the incidence of complications.