人为提高儿童肱骨髁上骨折外侧克氏针出针点的可行性及置针经验分析  

The feasibility and pinning expieriance of elevating the exit points of the proximal lateral pins in lateal pinning

作　　者：陈佳元 王恩波[1] 季相禄[1] 阿柳 贾国强[1] 刘天婧[1] Chen Jiayuan;Wang Enbo;Ji Xianglu;A Liu;Jia Guoqiang;Liu Tianjing(Department of Pediatric Orthopedics,Shengjing Hospital affiliated to China Medical University,Shenyang,110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿骨科,辽宁省沈阳市110004

出　　处：《临床小儿外科杂志》2021年第3期241-246,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(编号:81700459)。

摘　　要：目的初步探讨人为提高儿童肱骨髁上骨折外侧克氏针出针点的可行性及其相应的置入方法。方法本研究分为两个阶段。第一阶段:收集2016年3月至2016年12月中国医科大学附属盛京医院161例儿童伸直型肱骨髁上骨折外侧针构型病例术中透视图像中最外侧针的出针点和入针点位置,测量最外侧针冠状面和矢状面钢针角度。第二阶段(2017年1月至2017年12月)基于第一阶段的研究结果,由中国医科大学附属盛京医院两名小儿骨科医生尝试人为提高最外侧针的出针位置(预期组),另外两名外科医生继续按照常规流程置针(对照组),对两组各项治疗参数进行比较。结果第一阶段参与回顾性研究的161例患者中,47例(29.2%)最外侧针出针点位于骨干-干骺端交界区(metaphyseal-diaphyseal junction,MDJ)上边界线以上,其中40例最外侧针(85.1%)由肱骨小头骨化中心(ossific nucleus of the capitellum,ONC)外侧或骨化中心外1/3置入(正位像),于骨化中心后1/3或骨化中心后方置入(侧位像)。冠状面和矢状面钢针平均角度分别为58.4°和90.5°。第二阶段,预期组中有47例(65.3%,47/72)患者的最外侧针出针点位于MDJ上边界线以上,而对照组中仅32例(36%,32/89)出针点位于MDJ上边界线以上。两组比较差异有统计学意义(χ2=16.134,P<0.05)结论在单纯外侧针构型中,人为提高最外侧针出针点可行。钢针路径位于正位像肱骨小头骨化中心外侧、外1/3及侧位像在肱骨小头后方或后1/3位置时更容易获得高位的出针点。Objective To explore the highest exit height of the proximal lateral pins in lateral pinning and find out how to achieve a higher exit with proximal lateral pins.Methods In stage one of the study:form March 2016 to December 2017,the entry and exit points of the proximal pins of lateral pinning configuration were analyzed from intra-operative radiographs of children treated for extension-type supracondylar humerus fractures.The coronal and sagittal pin angles formed by the proximal pins were also measured.In stage two(from January 2017 to December 2017),Using the findings of stage one,two surgeons intentionally tried to achieve a more proximal exit with the proximal pins,while the other two surgeons continued to fix the fractures according to the regular,standard pinning protocol.Comparisons between groups of patients treated by random and intentional pinnings were donestatistically.Results In the first stage,47(29.2%)of the 161 proximal pins exited above the metaphyseal-diaphyseal junction(MDJ)region.Of these,85.1% entered from lateral and posterior to the ossific nucleus of the capitellum(ONC).The pin angles averaged 58.4°and 90.5°in the coronal and sagittal planes respectively.In the second stage,47(47/72,65.3%)proximal pins in the intended group exited above the MDJ region,while only 32(32/89,36%)in the contral group exited above the MDJ region.Conclusion With intention,the exit points of proximal pins in lateral pinning can be elevated safely and effectively.

关 键 词：肱骨骨折/外科学 骨折固定术 内 治疗结果 手术后并发症 

分 类 号：R683.41[医药卫生—骨科学] R726.1[医药卫生—外科学]