术中撬拨复位经皮交叉克氏针固定治疗儿童不稳定性屈曲型肱骨髁上骨折  

Intraoperative Prying Reduction and Kirschner Wire Cross Fixation for the Treatment of Unstable Flexion Supracondylar Fractures of the Humerus in Children

作　　者：屈继宁[1] 马益善 党幼婷 李云峰 李敏[1] 陆清达 苏菲 杨亚婷 孙川[1] 吴永涛[1] 颉强 QU Ji-ning;MA Yi-shan;DANG You-ting;LI Yun-feng;LI Min;LU Qing-da;SU Fei;YANG Ya-ting;SUN Chuan;WU Yong-tao;JIE Qiang(Children's Osteopathy Hospital,Red Cross Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院儿童骨病医院,西安710054

出　　处：《骨科》2022年第2期125-129,共5页ORTHOPAEDICS

基　　金：国家自然科学基金(81871743);陕西省创新能力支撑计划项目(2020TD-036)。

摘　　要：目的探讨术中撬拨复位经皮交叉克氏针固定治疗儿童不稳定性屈曲型肱骨髁上骨折的疗效。方法回顾性分析我院2015年1月至2019年6月收治的27例不稳定性屈曲型肱骨髁上骨折手法复位失败的儿童的临床资料,男13例,女14例;年龄为2~14岁,平均7.31岁。按照骨折移位程度分型,完全移位断端接触17例,完全移位断端无接触10例。合并尺神经损伤5例,均为闭合性损伤。所有病人在手法复位失败后均采用术中撬拨复位经皮交叉克氏针固定治疗。术后4~6周拔出克氏针,记录并发症发生情况,术后6个月参照Flynn肘关节功能评分标准评定疗效。结果病人手术时间为15~50 min,平均30 min。病人术中均覆盖防辐射铅衣保护,术中透视5~8次,平均7.5次。术后随访12~36个月,平均24个月。病人骨折愈合时间为4~6周,平均4.5周,术后3个月尺神经损伤均恢复。术后6个月参照Flynn肘关节功能评分标准评定疗效:优20例,良6例,可1例,优良率为98.8%(26/27)。所有病人均未发生肘内翻、骨化性肌炎、医源性神经损伤。结论撬拨复位经皮交叉克氏针固定是治疗儿童不稳定性屈曲型肱骨髁上骨折手法复位失败后的较为理想的复位方法。Objective To investigate the effect of prying reduction and percutaneous cross Kirschner wire fixation on unstable buckling supracondylar fracture of humerus in children.Methods The clinical data of 27 children with unstable flexion supracondylar humeral fractures treated in our hospital from January 2015to June 2019 were retrospectively analyzed,including 13 males and 14 females.The age ranged from 2 to 14years,with an average of 7.31 years.According to the degree of fracture displacement,there were 17 cases of completely displaced fracture end contact and 10 cases of completely displaced fracture end contact.There were 5 cases of ulnar nerve injury.After manual reduction failure,all patients were treated with intraoperative prying reduction and percutaneous cross Kirschner wire fixation.Kirschner wire was removed 4-6 weeks after surgery,and complications were recorded.The efficacy was evaluated 6 months after surgery according to Flynn’s elbow function score.Results The operation time of 27 patients was 15-50 min,with an average of 30 min.All patients were covered with radiation-proof lead clothing,and fluoroscopy was performed 5-8 times,with an average of 7.5 times.The patients were followed up for 12 to 36 months(mean 24 months).The healing time of all patients was 4-6 weeks,mean 4.5 weeks,and ulnar nerve injury was recovered 3 months after surgery.At 6months after the operation,the efficacy was evaluated according to Flynn elbow function scoring standard:excellent in 20 cases,good in 6 cases and fair in 1 case,with an excellent/good rate of 98.8%(26/27).None of the patients had cubital varus,myositis ossificans or iatrogenic nerve injury.Conclusion Prying reduction and percutaneous cross Kirschner wire fixation is an ideal method to treat unstable buckling supracondylar fractures of humerus in children.

关 键 词：肱骨髁上骨折 屈曲型 撬拨 闭合复位 儿童 

分 类 号：R726.8[医药卫生—儿科]