操纵杆辅助闭合复位治疗儿童不可复性肱骨髁上骨折

摘要
图/表
参考文献
相关文章 (7)

全文: PDF (1338 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨操纵杆辅助闭合复位治疗儿童不可复性肱骨髁上骨折的安全性及有效性。方法收集我院2016年1月至2018年10月收治的Gartland Ⅲ型肱骨髁上骨折645例，其中不可复性肱骨髁上骨折32例，14例采用“挤牛奶”手法后闭合复位获得成功，其余18例采用经肘关节后侧撬拨闭合复位成功，其中2例失访，获得完整随访16例。男12例，女4例；年龄3~12岁，平均(7.31±2.44)岁。术前合并正中神经症状7例，桡动脉搏动消失4例。复查随访术后X线片，记录末次随访Baumann角、提携角与健侧对比，末次随访采用Flynn肘关节功能评分进行功能评估。结果 16例随访时间4~13个月，平均(7.8±2.6)个月。健侧Baumann角与患侧术后Baumann角进行Shpiro-Wilk正态性检验，结果提示符合正态分布(健侧P＝0.37，患侧术后P＝0.64)，进行参数配对t检验(P＝0.17)，提示健侧与患侧术后Baumann角差异无统计学意义。同样方法进行健侧提携角并与患侧提携角统计学检验(P＝1.00)，差异无统计学意义。采用Flynn肘关节功能评分，优9例，良6例，中1例，优良率占93.75%。结论经肱三头肌后侧“操纵杆”复位技术可以作为闭合复位“不可复性”肱骨髁上骨折复位方法有效补充及辅助，在术后早期临床研究中安全有效。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：操纵杆, 闭合复位, 不可复, 肱骨髁上骨折

Abstract：Objective To investigate the safety and efficacy of joystick-assisted closed reduction in the treatment of the irreducible humerus supracondylar fracture.Methods Between January 2016 and October 2018，we collected 645 casesof Gartland type Ⅲ humerus condyle fracture in our hospital，including 32 casesof irreducible supracondylar fracture of humerus，14 cases of themunderwent successful close“milking”reduction，whilethe remaining 18 fractures were reducted sucessfully with joystick-assisted method.2 cases were lost during follow-up，and a total of 16 cases completed the follow-up.There were 12 males and 4 females.The ages between the children are 3 to 12 years old，the mean age was (7.31±2.44)years.There were 7 cases of preoperative median nerve symptoms and 4 cases of disappearance of radial pulse.Postoperative X-ray film was recorded.The Baumann angle and carrying angle were measured in the last follow-up and compared with the Control side.Flynn elbow joint function score was used for functional evaluation in the last follow-up.Results The shpiro-wilk normality test was conducted for the Baumann Angle on the healthy side and the injured side after surgery.The results indicated that the Baumann Angle on the healthy side was in line with the normal distribution (P＝0.37，P＝0.64 after surgery).The parametric paired t-test was performed (P＝0.17).There was no significant statistical difference between the healthy side and the postoperative Baumann Angle.By the same method，statistical test was conducted for the lifting Angle of the healthy side and the injured side (P＝1.00)，and there was no significant difference between the carrying angle and the healthy side.The score of Flynn elbow joint function was excellent in 9 cases，good in 6 cases，and good in 1 case，accounting for 93.75%.Conclusion The “joystick-assisted” closed reduction technique at the posterior side of triceps humerus can be used as an effective supplement and auxiliary method for the reduction of closed reduction and “irreducible” supracondylar fracture of humerus，which has been proved to be safe and effective in early clinical studies.

Key words： joystick closed reduction irreducible supracondylar fracture of humerus

基金资助:国家自然科学基金项目(81871743)
陕西省临床医学研究中心项目(2020LCZX-03)
陕西省创新能力支撑计划项目(2020TD-036)

通讯作者: 颉强

作者简介: 王晓威(1983－ )，男，主治医师，西安交通大学医学院附属红会医院小儿骨科诊疗中心，710054。

引用本文:

王晓威，汪兵，梁小菊，陆清达，苏菲，颉强 *. 操纵杆辅助闭合复位治疗儿童不可复性肱骨髁上骨折[J]. 实用骨科杂志, 2020, 26(9): 769-773.
Wang Xiaowei，Wang Bing，Liang Xiaoju，et al. Joystick Assisted Closed Reduction in the Treatment of Children with Irreducible Supracondylar Humerus Fractures. sygkzz, 2020, 26(9): 769-773.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I9/769

［1］Houshian S，Mehdi B，Larsen MS.The epidemiology of elbow fracture in children：analysis of 355 fractures，with special reference to supracondylar humerus fractures［J］.J Orthop Sci，2001，6(4)：312-315.
［2］Otsuka NY，Kasser JR.Supracondylar fractures of the humerus in children［J］.J Am Acad Orthop Surg，1997，5(1)：19-26.
［3］Kazimoglu C，Cetin M，Sener M，et al.Operative management of type Ⅲ extension supracondylar fractures in children［J］.Int Orthop 2009，33(4)：1089-1094.
［4］Leitch KK，Kay RM，Femino JD，et al.Treatment of multi directionally unstable supracondylar humeral fractures in children［J］.J Bone Joint Surg(Am)，2006，88(5)：980-985.
［5］Howard A，Mulpuri K，Abel MF，et al.The treatment of pediatric supracondylar humerus fractures［J］.J Am Acad Orthop Surg，2012，20(5)：320-327.
［6］Fleuriau-Chateau P，McIntyre W，Letts M.An analysis of open reduction of irreducible supracondylar fractures of the humerus in children［J］.Can J Surg，1998，41(2)：112-118.
［7］Kekomaki M，Luoma R，Rikalainen H，et al.Operative reduction and fixation of a difficult supracondylar fracture of the humerus［J］.J Pediatr Orthop，1984，4(1)：13-15.
［8］Blount WP.Fractures in children［M］.Baltimore：Williams & Wilkins，1954：26-28.
［9］Dekker AE，Krijnen P，Schipper IB.Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures：A systematic review and meta-analysis［J］.Injury，2016，47(11)：2391-2398.
［10］Slongo T，Schmid T，Wilkins K，et al.Lateral external fixation a new surgical technique for displaced unreducible supracondylar humeral fractures in children［J］.J Bone Joint Surg (Am)，2008，90(8)：1690-1697.
［11］Horst M，Altermatt S，Weber DM，et al.Pitfalls of lateral external fxation for supracondylar humeral fractures in children［J］.Eur J Trauma Emerg Surg，2011，37(4)：405-410.
［12］李旭，史强，吴伟平，等.闭合复位经皮穿针治疗儿童“不可复性"肱骨髁上骨折［J］.中华外科杂志，2015，53(10)：763-766.
［13］Li Jin，Rai Saroj，Tang Xin，et al.Surgical management of delayed Gartland type Ⅲ supracondylar humeral fractures in children：A retrospective comparison of radial external fixator and crossed pinning［J］.Medicine (Baltimore)，2020，99(10)：e19449.
［14］Flynn JC，Matthews JG，Benoit RL.Blind pinning of displaced supracondylar fractures of the humerus in children.Sixteen years' experience with long-term follow-up［J］.J Bone Joint Surg (Am)，1974，56(2)：263-272.
［15］Wilkins KE.The operative management of supracondylar fractures［J］.Orthop Clin North Am，1990，21(2)：269-289.
［16］Mangat KS，Martin AG，Bache CE.The“pulseless pink”hand after supracondylar fracture of the humerus in children［J］.J Bone Joint Surg(Br)，2009，91 (11)：1521-1525.
［17］Carcassonne M，Bergoin M，Hornung H.Results of operative treatment of severe supracondylar fractures of the elbow in children［J］.J Pediatr Surg，1972，7(6)：676-679.
［18］Millis MB，Singer IJ，Hall JE.Supracondylar fracture of the humerus in children.Further experience with a study in orthopaedic decisionmaking［J］.Clin Orthop Relat Res，1984(188)：90-97.
［19］Suh SW，Oh CW，Shingade VU，et al.Minimally invasive surgical techniques for irreducible supracondylar fractures of the humerus in children［J］.Acta Orthop，2005，76(6)：862-866.
［20］Kow RY，Zamri AR，Ruben JK，et al.Humeral supracondylar fractures in children：A novel technique of lateral external fixation and kirschner wiring［J］.Malays Orthop J，2016，10(2)：41-46.
［21］孙亮，刘万林，赵振群，等.操纵杆技术在儿童肱骨远端骨干干骺端交界性骨折中的应用［J］.中华小儿外科杂志，2020，41(4)：342-345.
［22］刘飞，楼跃，唐凯，等.操纵杆复位技术在弹性髓内钉固定治疗儿童股骨干骨折中的应用［J］.中华创伤骨科杂志，2013，15(11)：1005-1007.
［23］黄永波，张妍.三种方法治疗儿童桡骨颈骨折临床疗效分析［J］.中国药物与临床，2019，19(9)：1458-1460.
［24］Prashant K，Lakhotia D，Bhattacharyya TD，et al.A comparative study of two percutaneous pinning techniques (lateral vs medial-lateral) for Gartland type Ⅲ pediatric supracondylar fracture of the humerus［J］.J Orthop Traumatol，2016，17(3)：223-229.
［25］Padman M，Warwick AM，Fernandes JA，et al.Closed reduction and stabilization of supracondylar fractures of the humerus in children：the crucial factor of surgical experience［J］.J Pediatr Orthop B，2010，19(4)：298-303.