Xiong Zixuan,Zhao Huricha,Qi Kai,et al.Research advances of joystick-assisted closed reduction technique for multidirectional unstable supracondylar humeral fractures in children[J].Journal of Clinical Pediatric Surgery,2023,22(06):593-596.[doi:10.3760/cma.j.cn101785-202301022-019]
儿童多方向不稳定肱骨髁上骨折操纵杆辅助闭合复位技术的研究进展
- Title:
- Research advances of joystick-assisted closed reduction technique for multidirectional unstable supracondylar humeral fractures in children
- Keywords:
- Humeral Fractures; Fracture Fixation; Child
- 摘要:
- 儿童多方向不稳定肱骨髁上骨折的远端在冠状面、矢状面和水平面上会随着肘关节所处屈伸位置不同而呈现多方向且不稳定的状态。该类型骨折临床少见,手术中容易出现闭合复位和穿针固定困难,引发复位质量差和术后肘关节结构与功能恢复不良。辅助闭合复位技术治疗儿童多方向不稳定肱骨髁上骨折具有高效、安全、精准等特点,目前已成为临床关注焦点。本文就儿童多方向不稳定肱骨髁上骨折的临床特征以及操纵杆辅助闭合复位技术研究进展做一综述。
- Abstract:
- With flexion and extension positions of the elbow, distal end of supracondylar humeral fractures is both multidirectional and unstable in coronal, sagittal and horizontal planes in children.Although this type of fracture is rare in clinical practice, it is rather difficult to close reduction and pin fixation intraoperatively, leading to poor reduction quality and poor postoperative structural and functional recovery of the elbow.Assisted closed reduction technique for multidirectionally unstable supracondylar humeral fracture has attracted a lot of attention in children since it offers the characteristics of high efficiency, safety and accuracy.This review summarized the characteristics of multidirectionally unstable supracondylar humeral fractures and focused upon the research advances of pin joystick technique plus CRPP in children to enhance the clinical understanding of the characteristics of this fracture and further familiarize with the relevant auxiliary reduction techniques.
参考文献/References:
[1] Pavone V, Vescio A, Accadbled F, et al.Current trends in the treatment of supracondylar fractures of the humerus in children:results of a survey of the members of European Paediatric Orthopaedic Society[J].J Child Orthop, 2022, 16(3):208-219.DOI:10.1177/18632521221106379.
[2] Radaideh AM, Rusan M, Obeidat O, et al.Functional and radiological outcomes of different pin configuration for displaced pediatric supracondylar humeral fracture:a retrospective cohort study[J].World J Orthop, 2022, 13(3):250-258.DOI:10.5312/wjo.v13.i3.250.
[3] Boyd DW, Aronson DD.Supracondylar fractures of the humerus:a prospective study of percutaneous pinning[J].J Pediatr Orthop, 1992, 12(6):789-794.DOI:10.1097/01241398-199211000-00017.
[4] 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.DOI:10.5435/JAAOS-20-05-320.
[5] Omid R, Choi PD, Skaggs DL.Supracondylar humeral fractures in children[J].J Bone Joint Surg Am, 2008, 90(5):1121-1132.DOI:10.2106/JBJS.G.01354.
[6] Gartland JJ.Management of supracondylar fractures of the humerus in children[J].Surg Gynecol Obstet, 1959, 109(2):145-154.
[7] Leitch KK, Kay RM, Femino JD, et al.Treatment of multidirectionally unstable supracondylar humeral fractures in children.A modified Gartland type-IV fracture[J].J Bone Joint Surg Am, 2006, 88(5):980-985.DOI:10.2106/JBJS.D.02956.
[8] Swenson AL.The treatment of supracondylar fractures of the humerus by Kirschner-wire transfixion[J].J Bone Joint Surg Am, 1948, 30(4):993-997.DOI:10.2106/00004623-194830040-00023.
[9] Vaquero-Picado A, González-Morán G, Moraleda L.Management of supracondylar fractures of the humerus in children[J].EFORT Open Rev, 2018, 3(10):526-540.DOI:10.1302/2058-5241.3.170049.
[10] Su YX, Nan GX.Evaluation of a better approach for open reduction of severe Gartland type Ⅲ supracondylar humeral fracture[J].J Invest Surg, 2021, 34(5):479-485.DOI:10.1080/08941939.2019.1649766.
[11] 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.DOI:10.2106/JBJS.G.00528.
[12] 陈伟, 周英, 彭玉兰.儿童肱骨髁上骨折骨牵引与闭合复位内固定的疗效比较[J].临床骨科杂志, 2019, 22(6):716-719.DOI:10.3969/j.issn.1008-0287.2019.06.028. Chen W, Zhou Y, Peng YL.Efficacy comparison of bone traction and closed reduction and internal fixation for supracondylar humeral fracture in children[J].J Clin Orthop, 2019, 22(6):716-719.DOI:10.3969/j.issn.1008-0287.2019.06.028.
[13] Dineen HA, Stone J, Ostrum RF.Closed reduction percutaneous pinning of a pediatric supracondylar distal humerus fracture[J].J Orthop Trauma, 2019, 33(Suppl 1):S7-S8.DOI:10.1097/BOT.0000000000001523.
[14] Tarallo L, Novi M, Porcellini G, et al.Gartland type Ⅲ supracondylar fracture in children:is open reduction really a dangerous choice?[J].Injury, 2022, 53(Suppl 1):S13-S18.DOI:10.1016/j.injury.2021.02.071.
[15] 韦宜山, 娜木罕, 刁艳龙, 等.经尺骨鹰嘴操纵杆辅助闭合复位技术治疗儿童Gartland Ⅳ型肱骨髁上骨折手术潜在风险因素的对比研究[J].中国骨与关节杂志, 2021, 10(3):181-191.DOI:10.3969/j.issn.2095-252X.2021.03.005. Wei YS, Na MH, Diao YL, et al.A comparative study on potential risks of surgery in the treatment of Gartland type Ⅳ supracondylar humeral fracture with a transolecranon pin joystick in children[J].Chin J Bone Joint, 2021, 10(3):181-191.DOI:10.3969/j.issn.2095-252X.2021.03.005.
[16] Sharma A, Sethi A.Multidirectionally unstable supracondylar humeral fractures in children[J].JBJS Rev, 2019, 7(3):e3.DOI:10.2106/JBJS.RVW.18.00045.
[17] Silva M, Cooper SD, Cha A.The outcome of surgical treatment of multidirectionally unstable (type Ⅳ) pediatric supracondylar humerus fractures[J].J Pediatr Orthop, 2015, 35(6):600-605.DOI:10.1097/BPO.0000000000000344.
[18] 韦宜山, 刘万林, 王国强, 等.经尺骨鹰嘴操纵杆技术辅助闭合复位治疗儿童多方向不稳定肱骨髁上骨折[J].中华骨科杂志, 2020, 40(20):1397-1408.DOI:10.3760/cma.j.cn121113-20200311-00150. Wei YS, Liu WL, Wang GQ, et al.Clinical observation of utilizing a transolecranon pin joystick technique for multidirectionally unstable supracondylar humeral fractures in children[J].Chin J Orthop, 2020, 40(20):1397-1408.DOI:10.3760/cma.j.cn121113-20200311-00150.
[19] Mitchell SL, Sullivan BT, Ho CA, et al.Pediatric Gartland type-IV supracondylar humeral fractures have substantial overlap with flexion-type fractures[J].J Bone Joint Surg Am, 2019, 101(15):1351-1356.DOI:10.2106/JBJS.18.01178.
[20] DeFrancesco CJ, Shah AS, Brusalis CM, et al.Rate of open reduction for supracondylar humerus fractures varies across pediatric orthopaedic surgeons:a single-institution analysis[J].J Orthop Trauma, 2018, 32(10):e400-e407.DOI:10.1097/BOT.0000000000001262.
[21] 倪宏强, 楼跃.儿童肱骨髁上骨折的治疗进展[J].临床小儿外科杂志, 2020, 19(4):364-369, 376.DOI:10.3969/j.issn.1671-6353.2020.04.016. Ni HQ, Lou Y.Therapeutic advances of supracondylar humeral fractures in children[J].J Clin Ped Sur, 2020, 19(4):364-369, 376.DOI:10.3969/j.issn.1671-6353.2020.04.016.
[22] 文玉伟, 王强.儿童肱骨髁上骨折的诊疗进展[J].中华小儿外科杂志, 2017, 38(5):390-394.DOI 10.3760/cma.j.issn.0253-3006.2017.05.016. Wen YW, Wang Q.Recent advances in the diagnosis and treatment of supracondylar humeral fractures in children[J].Chin J Pediatr Surg, 2017, 38(5):390-394 DOI 10.3760/cma.j.issn.0253-3006.2017.05.016.
[23] Pirone AM, Graham HK, Krajbich JI.Management of displaced extension-type supracondylar fractures of the humerus in children[J].J Bone Joint Surg Am, 1988, 70(5):641-650.
[24] Aktekin CN, Toprak A, Ozturk AM, et al.Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures[J].J Pediatr Orthop B, 2008, 17(4):171-178.DOI:10.1097/BPB.0b013e3283046530.
[25] Turgut A, Aksakal AM, ?ztürk A, et al.A new method to correct rotational malalignment for closed reduction and percutaneous pinning in pediatric supracondylar humeral fractures[J].Acta Orthop Traumatol Turc, 2014, 48(5):611-614.DOI:10.3944/AOTT.2014.13.0031.
[26] Lee HY, Kim SJ.Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique[J].J Bone Joint Surg Br, 2007, 89(5):646-650.DOI:10.1302/0301-620X.89B5.18224.
[27] Novais EN, Andrade MAP, Gomes DC.The use of a joystick technique facilitates closed reduction and percutaneous fixation of multidirectionally unstable supracondylar humeral fractures in children[J].J Pediatr Orthop, 2013, 33(1):14-19.DOI:10.1097/BPO.0b013e3182724d07.
[28] Wei YS, Liu WL, Bai R, et al.The use of a transolecranon pin joystick technique in the treatment of multidirectionally unstable supracondylar humeral fractures in children[J].J Pediatr Orthop B, 2020, 29(5):452-457.DOI:10.1097/BPB.0000000000000787.
[29] Pei XH, Mo YQ, Huang P.Leverage application on Gartland type Ⅳ supracondylar humeral fracture in children[J].Int Orthop, 2016, 40(11):2417-2422.DOI:10.1007/s00264-016-3206-3.
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备注/Memo
收稿日期:2023-01-29。
基金项目:内蒙古自治区科技攻关计划项目(2021GG0207)
通讯作者:韦宜山,Email:weiyishan@sohu.com