Lu Yunan,Lin Ran,Pan Yuancheng,et al.Treatment of T-type intercondylar humeral fractures with closed reduction K-wire and cannulated screw internal fixation[J].Journal of Clinical Pediatric Surgery,2020,19(06):508-512.[doi:10.3969/j.issn.1671-6353.2020.06.009]
闭合复位克氏针空心钉内固定治疗青少年肱骨髁间T型骨折的疗效分析
- Title:
- Treatment of T-type intercondylar humeral fractures with closed reduction K-wire and cannulated screw internal fixation
- Keywords:
- Humeral Fractures; Fractures; Closed; Fracture Fixation; Adolescent
- 分类号:
- R726.8;R683.41;R687.3+2
- 摘要:
- 目的 探讨闭合复位克氏针空心钉内固定治疗青少年肱骨髁间T型骨折的方法与疗效。方法 回顾性分析厦门大学附属福州第二医院收治的18例青少年肱骨髁间T型骨折患儿的临床资料，所有患儿采用闭合复位并克氏针空心钉内固定，术后采用高分子石膏托固定肘关节4~6周，当影像学检查提示骨折端骨痂形成满意后拆除高分子石膏托并拔除克氏针，开始进行肘关节功能锻炼。结果 9例Mayo肘关节功能评分达到优，7例评分良，优良率为88.9%。只有1例术后未按时复查及功能锻炼，出现了肘关节疼痛及轻度肘关节僵硬等后遗症，肘关节功能评分55分。术后影像学评估提携角平均18°（范围：10°~27°），未出现肘关节内外翻畸形。患侧与健侧的肘关节肌力无明显差异。术后1例出现克氏针钉道感染，经换药拔针后治愈。1例术前合并正中神经损伤者，术后观察3个月恢复正常。结论 闭合复位克氏针空心钉内固定治疗青少年肱骨髁T型骨折简单实用、价格低廉且疗效满意，值得临床推广应用。
- Abstract:
- Objective To explore the approach and efficacy of closed reduction K-wire and cannulated screw internal fixation for adolescent T-type intercondylar fractures of humerus.Methods T-type intercondylar humeral fractures were analyzed retrospectively.Eighteen cases underwent closed reduction and internal fixation with K-wire and cannulated screw and elbow joints were fixed with high polymer plaster for 4-6 weeks.When imaging examination indicated at a statisfactory formation of osteotylus,high polymer plaster and K-wire were removed and elbow joint function exercise resumed.Results The Mayo elbow function score was optimal(n=9)and decent(n=7).The fine rate was 88.9%.One child failed to go through the review and perform functional exercise on time after operation.There were pain and stiffness and the MEPS score was merely 55.The mean carrying angle was 18°(10°-27°)without any deformities.No significant difference existed in elbow muscle strength between affected and healthy sides.One case of K-wire tract infection was cured after dressing change and needle extraction.Another case with median nerve injury before surgery was observed and normalized at 3 months after surgery.Conclusion Closed reduction K-wire and cannulated screw internal fixation are simple and effective for adolescent T-type intercondylar humeral fractures.With a low cost and a satisfactory efficacy,it is worthy of wider clinical promotion.
参考文献/References:
1 Landin LA,Danielsson LG.Elbow fractures in children.An epidemiological analysis of 589 cases[J].Acta Orthop Scand,1986,57(4):309-312.DOI:10.3109/17453678608994398.
2 Dreyfuss D,Eidelman M.Treatment of complex intercondylar humeral fractures in adolescents by open reduction and internal fixation through the transolecranon approach[J].J Pediatr Orthop B,2014,23(4):364-368.DOI:10.1097/BPB.0000000000000048.
3 Remia LF,Richards K,Waters PM.The Bryan-Morrey triceps-sparing approach to open reduction of T-condylar humeral fractures in adolescents:cybex evaluation of triceps function and elbow motion[J].J Pediatr Orthop,2004,24(6):615-619.DOI:10.1097/00004694-200411000-00003.
4 郭源,杨征.儿童肱骨髁间骨折切开复位及结果分析[J].中华小儿外科杂志,2006,27(2):84-86.DOI:10.3760/cma.j.issn.0253-3006.2006.02.009.Guo Y,Yang Z.Open reduction for children with intercondylar fracture[J].Chin J Pediatr Surg,2006,27(2):84-86.DOI:10.3760/cma.j.issn.0253-3006.2006.02.009.
5 Kundel K,Braun W,Wieberneit J,et al.Intraarticular distal humerus fractures.Factors affecting functional outcome[J].Clin Orthop Relat Res,1996,(332):200-208.DOI:10.1097/00003086-199611000-00027.
6 Morrey BF,Bryan RS,Dobyns JH,et al.Total elbow arthroplasty.A five-year experience at the Mayo Clinic[J].J Bone Joint Surg Am,1981,63(7):1050-1063.DOI:10.2106/00004623-198163070-00002.
7 Bryan RS,Morrey BF.Extensive posterior exposure of the elbow.A triceps-sparing approach[J].Clin Orthop Relat Res,1982,(166):188-192.DOI:10.1097/00003086-198206000-00033.
8 Popkin CA,Rosenwasser KA,Ellis HB Jr.Pediatric and Adolescent T-type Distal Humerus Fractures[J].J Am Acad Orthop Surg Glob Res Rev,2017,1(8):e040.DOI:10.5435/JAAOSGlobal-D-17-00040.
9 Rockwood C,Wilkins K,King R.Fractures in children 3rd ed[M].New York:JB Lippincott,1991:526-615.
10 Kanellopoulos AD,Yiannakopoulos CK.Closed reduction and percutaneous stabilization of pediatric T-condylar fractures of the humerus[J].J Pediatr Orthop,2004,24(1):13-16.DOI:10.1097/00004694-200401000-00003.
11 Julfiqar,Pant A,Huda N,et al.Closed reductions and percutaneus ’k’ wire fixation for adolescent intercondylar fractures of the distal humerus[J].J Clin Diagn Res,2013,7(8):1666-1668.DOI:10.7860/JCDR/2013/5695.3227.
12 Jung SW,Kang SH,Jeong M,et al.Triangular fixation technique for bicolumn restoration in treatment of distal humerus intercondylar fracture[J].Clin Orthop Surg,2016,8(1):9-18.DOI:10.4055/cios.2016.8.1.9.
13 Anari JB,Neuwirth AL,Carducci NM,et al.Pediatric T-condylar humerus fractures:a systematic review[J].J Pediatr Orthop,2017,37(1):36-40.DOI:10.1097/BPO.0000000000000588.
14 Beck NA,Ganley TJ,McKay S,et al.T-condylar fractures of the distal humerus in children:does early motion affect final range of motion?[J].J Child Orthop,2014,8(2):161-165.DOI:10.1007/s11832-014-0576-1.
15 冯伟,王强,宋宝健,等.肱骨髁上骨折解剖与功能复位早期临床功能的比较研究[J].临床小儿外科杂志,2018,17(10):769-773.DOI.10.3969/j.issn.1671-6353.2018.10.010.Feng W,Wang Q,Song BJ,et al.Differential anatomical or functional reduction of early clinical outcome for supracondylar humeral fractures[J].J Clin Ped Sur,2018,17(10):769-773.DOI.10.3969/j.issn.1671-6353.2018.10.010.
16 Cook JB,Riccio AI,Anderson T,et al.Outcomes after surgical treatment of adolescent intra-articular distal humerus fractures[J].J Pediatr Orthop,2016,36(8):773-779.DOI:10.1097/BPO.0000000000000555.
相似文献/References:
[1]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(06):0.
[2]王琪.儿童髂前上棘骨折27例疗效分析[J].临床小儿外科杂志,2010,9(03):0.
[3]王恩波 王康 张立军 赵群 吉士俊.儿童陈旧性肱骨外髁骨折的原因分析与预防对策[J].临床小儿外科杂志,2010,9(03):0.
WANG En-bo,WANG Kang,ZHANG Li-jun,et al.Analysis of the causes and prophylactic strategies for old lateral condyle fracture of humerus in children.[J].Journal of Clinical Pediatric Surgery,2010,9(06):0.
[4]蒋欣 陈小亮 王道喜 唐学阳 刘利君. 儿童四肢长骨病理性骨折手术治疗60例[J].临床小儿外科杂志,2011,10(05):337.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):337.
[5]吕洪海 陈蔚 王彭 杜智军. 弹性髓内针与交叉克氏针治疗儿童肱骨髁上[J].临床小儿外科杂志,2012,11(03):183.
[J].Journal of Clinical Pediatric Surgery,2012,11(06):183.
[6]邱继明,陈春华.弹性髓内针治疗儿童四肢长骨骨折33例[J].临床小儿外科杂志,2013,12(03):248.[doi:10.3969/j.issn.1671—6353.2013.03.028]
[7]姜海 刘建军 苗武胜. 闭合复位外侧经皮克氏针内固定治疗儿童GartlandⅢ型肱骨髁上骨折[J].临床小儿外科杂志,2013,12(06):486.
[8]冯伟 王强 宋宝健. 桡侧单臂外固定支架治疗儿童严重肱骨髁上骨折[J].临床小儿外科杂志,2014,13(05):415.
[9]赵艳君 陈海燕 陈纯. 应用SCL-90量表评估骨折患儿父母心理状况的调查研究[J].临床小儿外科杂志,2014,13(06):510.
[10]马长生 苏驰. 手法整复与经皮钢针内固定治疗儿童Gartland Ⅲ型肱骨髁上骨折1 100例[J].临床小儿外科杂志,2015,14(03):231.
备注/Memo
收稿日期:2019-12-07。
基金项目:福州市科技计划项目（编号：2018—S—101—3）
通讯作者:陈顺有,Email:csy508@163.com