Chen Jiayuan,Wang Enbo,Ji Xianglu,et al.The feasibility and pinning expieriance of elevating the exit points of the proximal lateral pins in lateal pinning[J].Journal of Clinical Pediatric Surgery,2021,20(03):241-246.[doi:10.12260/lcxewkzz.2021.03.008]
人为提高儿童肱骨髁上骨折外侧克氏针出针点的可行性及置针经验分析
- Title:
- The feasibility and pinning expieriance of elevating the exit points of the proximal lateral pins in lateal pinning
- Keywords:
- Humeral Fractures/SU; Fracture Fixation; Internal; Treatment Outcome; Postoperative Complications
- 分类号:
- R683.41;R726.1
- 摘要:
- 目的 初步探讨人为提高儿童肱骨髁上骨折外侧克氏针出针点的可行性及其相应的置入方法。方法 本研究分为两个阶段。第一阶段：收集2016年3月至2016年12月中国医科大学附属盛京医院161例儿童伸直型肱骨髁上骨折外侧针构型病例术中透视图像中最外侧针的出针点和入针点位置，测量最外侧针冠状面和矢状面钢针角度。第二阶段（2017年1月至2017年12月）基于第一阶段的研究结果，由中国医科大学附属盛京医院两名小儿骨科医生尝试人为提高最外侧针的出针位置（预期组），另外两名外科医生继续按照常规流程置针（对照组），对两组各项治疗参数进行比较。结果 第一阶段参与回顾性研究的161例患者中，47例（29.2%）最外侧针出针点位于骨干-干骺端交界区（metaphyseal-diaphyseal junction，MDJ）上边界线以上，其中40例最外侧针（85.1%）由肱骨小头骨化中心（ossific nucleus of the capitellum，ONC）外侧或骨化中心外1/3置入（正位像），于骨化中心后1/3或骨化中心后方置入（侧位像）。冠状面和矢状面钢针平均角度分别为58.4 °和90.5 °。第二阶段，预期组中有47例（65.3%，47/72）患者的最外侧针出针点位于MDJ上边界线以上，而对照组中仅32例（36%，32/89）出针点位于MDJ上边界线以上。两组比较差异有统计学意义（χ2=16.134，P<0.05）结论 在单纯外侧针构型中，人为提高最外侧针出针点可行。钢针路径位于正位像肱骨小头骨化中心外侧、外1/3及侧位像在肱骨小头后方或后1/3位置时更容易获得高位的出针点。
- Abstract:
- Objective To explore the highest exit height of the proximal lateral pins in lateral pinning and find out how to achieve a higher exit with proximal lateral pins.Methods In stage one of the study:form March 2016 to December 2017,the entry and exit points of the proximal pins of lateral pinning configuration were analyzed from intra-operative radiographs of children treated for extension-type supracondylar humerus fractures.The coronal and sagittal pin angles formed by the proximal pins were also measured.In stage two(from January 2017 to December 2017),Using the findings of stage one,two surgeons intentionally tried to achieve a more proximal exit with the proximal pins,while the other two surgeons continued to fix the fractures according to the regular,standard pinning protocol.Comparisons between groups of patients treated by random and intentional pinnings were donestatistically.Results In the first stage,47 (29.2%) of the 161 proximal pins exited above the metaphyseal-diaphyseal junction (MDJ) region.Of these,85.1% entered from lateral and posterior to the ossific nucleus of the capitellum (ONC).The pin angles averaged 58.4?nd 90.5°in the coronal and sagittal planes respectively.In the second stage,47 (47/72,65.3%)proximal pins in the intended group exited above the MDJ region,while only 32 (32/89,36%) in the contral group exited above the MDJ region.Conclusion With intention,the exit points of proximal pins in lateral pinning can be elevated safely and effectively.
参考文献/References:
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,2001,6:312-315.DOI:10.1007/s007760100024.
2 Abdel Karim M,Hosny A,Nasef Abdelatif NM,et al.Crossed Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees[J].J Orthop Trauma,2016,30(4):e123-e128.DOI:10.1097/BOT.0000000000000473.
3 Dekker AE,Krijnen P,Schipper IB.Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures:Asystematic review and meta-analysis[J].Injury,2016,47:2391-2398.DOI:10.1016/j.injury.2016.08.022.
4 朱丹江,王强,宋宝健,等.闭合复位与经皮桡侧交叉克氏针固定治疗儿童肱骨髁上骨折[J].临床小儿外科杂志,2016,15(5):477-480.DOI:10.3969/j.issn.1671-6353.2016.05.018. Zhu DJ,Wang Q,Song BJ,et al.Closed reduction and percutaneous radial crossed pinning of supracondylar fractures of the humerus in children[J].J Clin Ped Sur,2016,15(5):477-480.DOI:10.3969/j.issn.1671-6353.2016.05.018.
5 Pennock AT,Charles M,Moor M,et al.Potential causes of loss of reduction in supracondylar humerus fractures[J].J Pediatr Orthop,2014,34(7):691-697.DOI:10.1097/BPO.0000000000000154.
6 Gottschalk HP,Sagoo D,Glaser D,et al.Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures:does starting point,pin size,and number matter?[J].J Pediatr Orthop,2012,32(5):445-451.DOI:10.1097/BPO.0b013e318257d1cd.
7 Slobogean BL,Jackman H,Tennant S,et al.Iatrogenic ulnar nerve injury after the surgical treatment of displaced supra-condylar fractures of the humerus:number needed to harm:a systematic review[J].J Pediatr Orthop,2010,30(5):430-436.DOI:10.1097/BPO.0b013e3181e00c0d.
8 Hamdi A,Poitras P,Louati H,et al.Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures[J].J Pediatr Orthop,2010,30(2):135-139.
9 Larson L,Firoozbakhsh K,Passarelli R,et al.Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures[J].J Pediatr Orthop,2006,26(5):573-578.DOI:10.1097/01.bpo.0000230336.26652.1c.
10 Liu C,Kamara A,Liu T,et al.Mechanical stability study of three techniques used in the fixation of transverse and oblique metaphyseal-diaphyseal junction fractures of the distal humerus in children:a finite element analysis[J].J Orthop Surg Res,2020,15(1):34.DOI:10.1186/s13018-020-1564-4
11 Lee YH,Lee SK,Kim BS,et al.Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children[J].J Pediatr Orthop,2008,28(4):417-422.DOI:10.1097/BPO.0b013e318173e13d.
12 Scaglione M,Giovannelli D,Fabbri L,et al.Supracondylar humerus fractures in children treated with closed reduction and percutaneous pinning[J].Musculoskelet Surg,2012,96(2):111-116.DOI:10.1007/s12306-012-0204-5.
13 Reisoglu A,Kazimoglu C,Hanay E,et al.Is pin configuration the only factor causing loss of reduction in the management of pediatric type Ⅲ supracondylar fractures?[J].Acta Orthop Traumatol Turc,2017,51(1):34-38.DOI:10.1016/j.aott.2016.11.003.
14 Fayssoux RS,Stankovits L,Domzalski ME,et al.Fractures of the distal humeral metaphyseal-diaphyseal junction in children[J].J Pediatr Orthop,2008,28(2):142-146.DOI:10.1097/BPO.0b013e3181653af3.
15 Kamara A,Ji X,Liu T,et al.A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children[J].Int Orthop,2019,43(2):411-416.DOI:10.1007/s00264-018-3968-x.
16 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,2016,15(5):457-459.DOI:10.3969/j.issn.1671-6353.2016.05.013.
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(03):0.
[2]张路,覃佳强,李明,等.可吸收螺钉治疗儿童肱骨外髁骨折40例[J].临床小儿外科杂志,2008,7(02):6.
[3]孙燕,廖怀章,孙炜,等.经桡骨Lister结节髓内固定治疗儿童尺桡骨干骨折40例[J].临床小儿外科杂志,2008,7(02):26.
[4]王强,宋宝健.髋人字支具固定治疗婴幼儿股骨骨折23例[J].临床小儿外科杂志,2008,7(05):1.
[5]宋宝健 王强 孙琳 侯大为. 单臂上肢外固定器治疗小儿肱骨近端骨折[J].临床小儿外科杂志,2011,10(03):167.
[J].Journal of Clinical Pediatric Surgery,2011,10(03):167.
[6]汪兵 苗武胜 张亮 吴永涛 张博浩.克氏针张力带固定治疗儿童陈旧性肱骨外髁骨折的疗效观察[J].临床小儿外科杂志,2011,10(03):176.
[J].Journal of Clinical Pediatric Surgery,2011,10(03):176.
[7]杜智军 吕洪海 王彭. 弹性髓内针固定治疗青少年锁骨中段骨折[J].临床小儿外科杂志,2012,11(01):4.
[8]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(03):183.
[9]易新成 鲍琨 陈博昌. 空心钉克氏针内固定治疗儿童陈旧性肱骨外髁骨折近期疗效观察[J].临床小儿外科杂志,2014,13(03):180.
[10]吴海艺,梁龙芳,裴新红.弹性髓内钉单骨固定治疗儿童前臂双骨折的疗效Meta分析[J].临床小儿外科杂志,2019,18(11):941.[doi:10.3969/j.issn.1671—6353.2019.11.009]
Wu Haiyi,Liang Longfang,Pei Xinhong.The effect of elastic stable intramedullary nailing single bone fixation in pediatric both bone forearm fractures: A Meta-analysis[J].Journal of Clinical Pediatric Surgery,2019,18(03):941.[doi:10.3969/j.issn.1671—6353.2019.11.009]
[11]丁波,彭立君.肱骨髁上骨折增加外固定时间的疗效观察[J].临床小儿外科杂志,2007,6(04):35.
[12]肖元,周英,刘昕,等.切开复位交叉克氏针内固定术治疗难复性肱骨远端全骺分离26例[J].临床小儿外科杂志,2021,20(01):56.[doi:10.12260/lcxewkzz.2021.01.011]
Xiao Yuan,Zhou Ying,Liu Xin,et al.Clinical efficacies of open reduction plus internal fixation of cross Kirschner wire for difficult-to-reduce distal humeral epiphysis separations[J].Journal of Clinical Pediatric Surgery,2021,20(03):56.[doi:10.12260/lcxewkzz.2021.01.011]
[13]姜鹏,陈武平,林鸿旺,等.儿童Gartland Ⅱ型肱骨髁上骨折保守治疗和手术治疗的效果比较[J].临床小儿外科杂志,2021,20(07):646.[doi:10.12260/lcxewkzz.2021.07.010]
Jiang Peng,Chen Wuping,Lin Hongwang,et al.Comparison of conservative and surgical treatment for Gartland type Ⅱ supracondylar humeral fracture in children[J].Journal of Clinical Pediatric Surgery,2021,20(03):646.[doi:10.12260/lcxewkzz.2021.07.010]
备注/Memo
收稿日期:2020-05-24。
基金项目:国家自然科学基金（编号：81700459）
通讯作者:王恩波,Email:wangenbodor@163.com