克氏针撬拨协助复位治疗儿童肱骨髁上Gartland ⅢB、Ⅳ型骨折的临床疗效分析  

Clinical analysis of Kirschner wire prying assisted reduction for treatinghumeral supracondylar Gartland ⅢB/Ⅳtype fracture in children

作　　者：车伟 陈进 朱庆华 CHE Wei;CHEN Jin;ZHU Qinghua(Department of Pediatric Surgery,First Affiliated Hospital of Wannan Medical College,Yijishan Hospital,Wuhu,Anhui 241000,China)

机构地区：[1]皖南医学院第一附属医院/弋矶山医院小儿外科,安徽芜湖241000

出　　处：《重庆医学》2024年第11期1640-1644,共5页Chongqing medicine

基　　金：安徽省高校自然科学研究项目(KJ2020A0617)。

摘　　要：目的 探讨术中采用克氏针撬拨协助复位治疗极不稳定的儿童肱骨髁上GartlandⅢB、Ⅳ型骨折的临床疗效。方法 选取2021年9月至2022年8月诊断为儿童肱骨髁上GartlandⅢB、Ⅳ型骨折的患儿37例,术中尝试手法复位两次失败后,利用克氏针撬拨协助复位完成经皮克氏针固定。记录手术时间、骨折愈合时间、术中尺神经损伤情况,术后浅深部感染、骨化性肌炎及肘关节内翻畸形并发症;术后6个月采用Flynn评分评价患侧肘关节功能。结果 所有患儿均顺利完成手术,无中转开放手术、尺神经损伤发生,平均手术时间为(45.78±10.35)min。术后所有患儿均获随访,患儿骨折愈合时间为4~6周,平均(5.14±0.67)周,术后随访无浅深部感染、肘关节骨化性肌炎、肘关节内翻畸形并发症发生,术后6个月肘关节Flynn评分优30例、良6例、中1例,优良率达97.3%。结论 克氏针撬拨协助复位治疗儿童肱骨髁上GartlandⅢB、Ⅳ型骨折疗效肯定,该技术具有创伤小、操作简单且安全等优点,值得推广。Objective To investigate the clinical effect of Kirschner wire prying assisted reduction in the treatment of extremely unstable humeral supracondylar GartlandⅢB/Ⅳtype fracture in children.Methods Thirty-seven children patients with diagnosed humeral supracondylar GartlandⅢB/Ⅳtype fracture in this hospital from September 2021 to August 2022 were selected.After two unsuccessful attempts at manual reduction during the operation,the Kirschner wire prying was used to assist in reduction and complete percutaneous Kirschner wire fixation.The operation time,fracture healing time,intraoperative ulnar nerve injury,postoperative superficial and deep infection,ossifying myositis and elbow varus deformity were recorded.The function of elbow joint in the affected side was evaluated by the Flynn score in postoperative 6 months.Results All operations in the children patients were successfully completed.No case was converted to open operation and had ulnar nerve injury.The mean operation time was(45.78±10.35)min.All children patients were followed up after the operation.The fracture healing time after the operation in all children patients was 4-6 weeks,with an average time of(5.14±0.67)weeks.No case of superficial and deep infection was found during the postoperative follow-up,and no case of ossifying myositis and elbow varus deformity was found.In the elbow joint Flynn score in postoperative 6 months,there were excellent in 30 cases,good in 6 cases,medium in 1 case,the excellent and good rates reached 97%.Conclusion Kirschner wire prying assisted reduction in the treatment of humeral supracondylar GartlandⅢB/Ⅳtype fracture in children has definite effect,this technique has the advantages of small trauma,simple operation and safety,which is worthy of promotion.

关 键 词：髁上骨折 克氏针 撬拨复位 临床疗效 

分 类 号：R726.8[医药卫生—儿科]