超声引导下逆行克氏针内固定治疗大龄儿童锁骨干骨折  

Ultrasound guided retrograde Kirschner wire internal fixation for the treatment of midshaft clavicle fractures in older children

作　　者：姚凌峰 印飞[1] 冯澜 王金萍 王军[1] 顾珺 林伟枫 信天游 Yao Lingfeng;Yin Fei;Fen Lan;Wang Jinping;Wang Jun;Gu Jun;Lin Weifeng;Xin Tianyou(Department of Pediatric Orthopedics,Wuxi No.9 People's Hospital Affiliated to Soochow University,Wuxi 214000,China)

机构地区：[1]苏州大学附属无锡九院小儿骨科,无锡214000

出　　处：《中华手外科杂志》2024年第6期505-508,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨实时超声引导下逆行克氏针进针法辅助闭合复位内固定治疗大龄儿童锁骨干骨折的临床疗效。方法我院自2020年1月至2023年10月收治儿童锁骨干骨折患儿27例,男19例,女8例。手术方式均采用超声引导下逆行克氏针进针法结合闭合复位克氏针内固定。全程使用超声进行监控,实时超声引导下穿刺逆行进针、闭合复位、顺行进针、固定完成后检查骨折复位质量,最后C臂机透视验证复位效果。结果手术均顺利完成,闭合复位成功率100%,无血管神经损伤、针道感染、克氏针断裂、骨折畸形愈合、骨折不愈合等并发症发生。所有患儿均获得随访,时间7~10个月,平均8.6个月。骨折愈合后即行克氏针取出,愈合时间4~~5周,平均4.3周,患侧肢体达到完全正常活动范围为7~10周,平均8.2周。术后4个月随访患儿QuickDASH评分6.5±1.5分,所有患儿MRC肌力评分均为5分。术后半年随访患儿功能、肌力均正常,未出现再骨折、锁骨短缩畸形等情况。结论超声引导下逆行克氏针进针法行内固定治疗大龄儿童锁骨干骨折具有微创、疗效确切、并发症少、减少放射性损害等优点,操作简单、学习曲线短,便于临床推广。Objective To explore the clinical efficacy of real-time ultrasound-guided retrograde Kirschner wire insertion assisted closed reduction and internal fixation in the treatment of midshaft clavicle fractures in older children.Methods From January 2020 to October 2023,27 children with midshaft clavicle fractures were treated,including 19 males and 8 females.The surgical method adopted ultrasound-guided retrograde Kirschner wire insertion combined with closed reduction Kirschner wire internal fixation.The entire process was monitored using ultrasound,and real-time ultrasound guidance was used to perform retrograde needle insertion,closed reduction,anterograde needle insertion,and fixation.After completion,the quality of fracture reduction was checked,and finally the reduction effect was verified by C-arm fluoroscopy.Results The surgery was successfully completed with a 100%success rate of closed reduction,and there were no complications such as vascular and nerve injury,needle infection,Kirschner wire fracture,malunion of fractures,or nonunion of fractures.All patients were follow-up for 7 to 10 months,with an average of 8.6 months.After the fracture healed,the Kirschner wire was immediately removed,and the healing time was 4 to 5 weeks,with an average of 4.3 weeks.The affected limb reached a completely normal range of motion in 7 to 10 weeks,with an average of 8.2 weeks.Four months after surgery,the Quick DASH score of the children was(6.5±1.5)points,and the MRC muscle strength score of all children was 5 points.The follow-up results six months after surgery showed that the child's function and muscle strength were normal,and no further fractures or clavicle shortening deformities occurred.Conclusion Ultrasound guided retrograde Kirschner wire insertion method for internal fixation ofmidshaft clavicle fractures in older children has the advantages of minimally invasive,precise efficacy,few complications,and reduced radiation damage.It is easy to operate,has a short learning curve,and is convenient for clinical prom

关 键 词：锁骨 骨折 超声 闭合复位 骨折固定术 克氏针 

分 类 号：R726.8[医药卫生—儿科]