微创小切口辅助克氏针操纵杆技术治疗儿童肱骨外髁骨折  

Mini-invasive incision assisted Kirschner’s joystick maneuver for lateral humeral condylar fractures in children

作　　者：吴敏[1] 易申德[1] 曾群群 袁蔡晖 Wu Min;Yi Shende;Zeng Qunqun;Yuan Caihui(Department of Orthopedics,Jiangxi Provincial Children's Hospital,Nanchang 330006,China;Department of Radiology,Jiangxi Provincial Children's Hospital,Nanchang 330006,China)

机构地区：[1]江西省儿童医院骨科,南昌330006 [2]江西省儿童医院放射科,南昌330006

出　　处：《中华小儿外科杂志》2024年第6期521-524,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的研究微创小切口辅助克氏针操纵杆技术治疗儿童肱骨外髁骨折的临床效果。方法收集2019年6月至2021年6月江西省儿童医院收治的36例肱骨外髁骨折患儿的临床资料,其中男29例,女7例;年龄为(4.62±1.92)岁。患儿均采用小切口辅助克氏针操纵杆技术撬拨复位肱骨外髁骨折。记录手术切口长度、手术时间、术中出血量,观察术后骨折有无再移位、神经损伤、感染、骨折愈合时间、肘内外翻畸形发生、肱骨小头坏死等,末次随访采用Dhillon肘关节评分评价关节功能。结果所有患儿均获得解剖复位,无一例出现中转延长切口。手术切口长约(2.01±0.25)cm,范围为1.5~2.5 cm;手术时间为(33.06±9.07)min,范围为15~60 min;平均术中出血约5 ml,术后随访时间为12~26个月。所有骨折均得到愈合,时间为(8.5±2.6)周,范围为8~16周。术后1例患儿出现针尾皮肤激惹,予以清创拔除克氏针,于门诊换药及抗感染治疗后痊愈;3例出现局部皮肤隆起,活动时有疼痛,克氏针取出后症状完全消失;24例影像学上观察到外髁"骨刺"。末次随访按照Dhillon评分系统评价肘关节功能,优35例,良1例,优良率100%,无一例出现感染、骨不连、肘内外翻畸形、肱骨小头坏死等。结论微创小切口辅助克氏针操纵杆技术治疗儿童肱骨外髁骨折效果良好,该技术操作简单、方便,手术创伤小、瘢痕小、术后美观,值得推广。Objective To explore the clinical efficacy of mini-invasive incision assisted Kirschner’s joystick technique for lateral humeral condylar fracture in children.Methods From June 2019 to June 2021,36 children of lateral humeral condylar fractures underwent mini-invasive assisted Kirschner's joystick maneuver.General profiles,incisional length,operative duration and intraoperative volume of blood loss were recorded.Postoperative displacement of fracture,nerve injury,infection,fracture healing time,occurrence of cubitus varusor valgus deformity and necrosis of humeral capitulum were observed.After the last follow-up,joint function was assessed by Dhillon elbow joint score.Results All anatomic reductions were successful without any extended incision.Average incisional length was(2.01±0.25)(1.5-2.5)cm,average operative duration(33.06±9.07)(15-60)mins and average volume of blood loss 5 ml.During a follow-up period of(12-26)months,all fractures healed within(8.5±2.6)(8-16)weeks.One case of skin irritation at needle tip was cured after removing K-wire,outpatient dressing changes and antibiotic therapy.Three cases of local skin elevation and activity pain resolved completely after removing K-wire.Spur was evident on lateral condylar radiograph(n=24).At the last follow-up,Dhillon score of elbow joint function was excellent(n=35)and decent(n=1)with an excellent/decent rate of 100%.None had infection,nonunion,cubitus varusor valgus deformity or necrosis of humeral capitulum.Conclusions The mini-invasive incision assisted Kirschner’s joystick technique is efficacious for lateral humeral condylar fracture in children.This simple,convenient,mini-invasive,scarless and cosmetic procedure is worth a wider popularization.

关 键 词：关节内骨折 儿童 肱骨外髁骨折 克氏针 切开复位 

分 类 号：R726.8[医药卫生—儿科]