Li Xin,Wei Yishan,Zhou Zhaohui,et al.Surgical techniques and outcomes of closed reduction and percutaneous fixation for Toniolo-Wilkins-Canavese type Ⅲ intercondylar T-type distal humerus fractures in children and adolescents[J].Journal of Clinical Pediatric Surgery,2026,(08):775-779.[doi:10.3760/cma.j.cn101785-20260129-00044]
闭合复位经皮内固定治疗儿童及青少年TWC Ⅲ型肱骨远端T型髁间骨折的疗效分析
- Title:
- Surgical techniques and outcomes of closed reduction and percutaneous fixation for Toniolo-Wilkins-Canavese type Ⅲ intercondylar T-type distal humerus fractures in children and adolescents
- Keywords:
- Closed Reduction of Fractures; Percutaneous Internal Fixation; Intercondylar Fracture of Humerus; Kirschner Wire Fixation; Imaging; Child; Adolescents
- 摘要:
- 目的 观察闭合复位经皮内固定治疗儿童及青少年Toniolo-Wilkins-Canavese（TWC）Ⅲ型肱骨远端T型髁间骨折的临床效果，分析随访期间影像学对线变化，比较末次随访时患侧与健侧影像学参数的差异。方法 本研究为回顾性病例系列研究。收集2014年12月至2025年12月于内蒙古医科大学第二附属医院儿童骨科医学中心接受闭合复位经皮内固定治疗的41例TWC Ⅲ型肱骨远端T型髁间骨折患儿临床资料，固定方式包括单纯克氏针固定和克氏针联合空心螺钉固定。记录患儿一般资料、手术时间及随访时间；分别于术后即刻、术后3个月及末次随访时测量患肘Baumann角和侧位肱头角，比较不同时间点测量值的差异；末次随访时测量健侧对应参数，并与患侧进行配对比较。采用Mayo肘关节功能评分（Mayo Elbow Performance Score,MEPS）评价末次随访时肘关节功能，并记录术后并发症。结果 41例均完成闭合复位经皮内固定治疗，手术时间（39.93±6.77）min，随访时间12（9，24）个月。患肘Baumann角及侧位肱头角在术后即刻、术后3个月及末次随访时进而组内比较，差异均无统计学意义（P＞0.05）。末次随访时，患侧Baumann角（75.68±3.65）°高于健侧（73.06±3.57）°，差异具有统计学意义（P＜0.001）；患侧与健侧侧位肱头角差异无统计学意义（P＝0.233）。41例MEPS评分（91.00±4.42）分，其中优31例、良10例，优良率100.0%。出现并发症6例，经处理后均未影响最终肘关节功能。结论 在严格掌握适应证的前提下，闭合复位经皮内固定可作为儿童及青少年TWC Ⅲ型肱骨远端T型髁间骨折的微创治疗选择。术后影像学对线总体稳定，末次随访时患侧影像学参数处于可接受范围，肘关节功能恢复良好。
- Abstract:
- Objective To evaluate the clinical outcomes of closed reduction and percutaneous internal fixation for type Ⅲ Toniolo-Wilkins-Canavese (TWC) distal humeral T-shaped intercondylar fractures in children and adolescents,examine radiographic alignment changes during follow-ups and compare the differences in radiographic parameters between affected and unaffected sides at the final follow-up. Methods Retrospective analysis was conducted for 41 children with type Ⅲ TWC distal humeral intercondylar fractures undergoing closed reduction and percutaneous internal fixation at Department of Pediatric Orthopedics,Second Affiliated Hospital of Inner Mongolia Medical University from December 2014 to December 2025.The fixation methods included either K-wiring alone or a combination of K-wires and cancellous screws.Personal demographics,operative duration and follow-up studies were recorded.Baumann angle and lateral humeral head angle of the affected elbow were measured immediately postoperatively,at 3 months postoperatively and at the final follow-up; intra-group comparisons were performed across different timepoints.At the final follow-up,the corresponding parameters of contralateral side were measured and compared with those of affected side using paired analysis.Elbow function at the final follow-up was assessed by Mayo Elbow Performance Score (MEPS) and postoperative complications were documented. Results All procedures were performed, with a mean operative duration of (39.93±6.77) minutes and a median follow-up of 12(9,24) months.No statistically significant differences existed in Baumann angle or lateral humeral head angle at immediate postoperative,3-month postoperative and final follow-up assessments (P>0.05).At the final follow-up,affected side’s Baumann angle was significantly higher than that of contralateral side (P<0.001) while no significant difference existed between two sides in lateral humeral head angle (P=0.233).MEPS score was (91.00±4.42) points with excellent results (n=31) and good results (n=10),achieving an excellent-to-good rate of 100.0%.After treatments,6 complications resolved without affecting the final functional outcome. Conclusion With strict indication selecting,closed reduction and percutaneous fixation may be a mini-invasive treatment for TWC type Ⅲ distal humeral T-condylar fractures in children and adolescents.Radiographic alignment remains generally stable during follow-ups.The radiographic parameters at the affected side are overall within an acceptable range at the final follow-up with satisfactory elbow function recovery.
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备注/Memo
收稿日期:2026-1-29。
基金项目:内蒙古自然科学基金(2021GG0207)
通讯作者:韦宜山,Email:3276844912@qq.com