目的探讨超声引导下闭合复位克氏针固定治疗不稳定型肱骨外髁骨折手术疗效及超声闭合复位成功可接受标准。
方法回顾性分析2021年1月至2022年11月安徽医科大学附属省儿童医院和安徽医科大学附属阜阳人民医院收治的106例不稳定型肱骨外髁骨折患儿资料，其中男70例，女36例；年龄为（5.0±2.0）岁；患侧为左侧55例，右侧51例。所有患儿均接受超声引导下闭合复位克氏针固定治疗，统计围手术期手术时间、术中出血量、透视次数等，采用配对 t检验比较健侧与患侧功能指标。末次随访时评估患侧X线片、肘关节Mayo评分及并发症情况。分析Mayo评分95分及以上患儿超声图像，探讨冠状面、矢状面等复位成功可接受标准。
结果超声引导下闭合复位率为88%（94/106），患儿手术时间为（54.6±21.1）min，透视次数为（9.3±2.9）次，出血量为（6.8±2.1）ml。随访（15.7±14.4）个月，末次随访时患肘屈曲角度为138.8°±6.9°，与健侧140.1°±5.9°比较差异有统计学意义（ P=0.01）；患侧旋转和伸肘功能与健侧的差异无统计学意义（ P>0.05）。所有患儿Baunnman角为71.4°±5.4°、髁干角为39.9°±6.4°、提携角为8.4°±3.6°，患侧肘关节Mayo评分为（90.1±4.8）分，Mayo评分在95分及以上有38例。14例患儿针道浅表感染，1例术后轻度再移位，无骨骺阻滞、肘关节外翻畸形、延迟愈合和不愈合。根据38例患儿超声影像学特征，闭合复位可接受标准主要在冠状面平行关节面、冠状面垂直关节面、矢状面垂直关节面和后外侧矢状面垂直关节面4个层面判断。
结论超声引导下闭合复位克氏针固定治疗不稳定型肱骨外髁骨折，术中失血少、辐射少，中短期随访疗效较好，超声4个层面判断闭合复位可接受标准具有可行性。
ObjectiveTo assess the outcomes of ultrasound-guided closed reduction and Kirschner wire fixationof unstable humeral lateral condyle fractures and to determine the criteria for successful reduction.
MethodsA retrospective analysis was conducted on the data of 106 children with unstable humeral lateral condylefractures admitted to the Anhui Provincial Children's Hospital of Anhui Medical Universityand thePeople's Hospital of Fuyang of Anhui Medical Universityfrom January 2021 to November 2022. Among the enrolled 106 children, there were 70 males and 36 females with an average age of 5.0±2.0 years. There were 55 cases of left-sided fractures, and 51 right-sided cases. All participants were surgically treated with ultrasound-guided closed reduction and Kirschner wire fixation of unstable humeral lateral condyle fractures. Perioperative surgical time, intraoperative blood loss, and number of fluoroscopy sessions were recorded. Functional indicators between the affected and unaffected sides were compared by the paired t-test. X-ray scans of the affected side, the Mayo score for the elbow and complications were assessed at the last follow-up visit. Ultrasound scans in children graded 95 points or above of the Mayo score were analyzed to formulate the criteria for a success reduction in coronal and sagittal planes.
ResultsThe closed reduction rate under ultrasound guidance, surgical time, number of fluoroscopy sessions and intraoperative blood loss was 88% (94/106), 54.6±21.1 min, 9.3±2.9 times, and 6.8±2.1 ml. After an average follow-up of 15.7±14.4 months, the affected elbow could flex to 138.8°±6.9°, showing a significant difference when comparing with that on the contralateral side (140.1°±5.9°) ( P=0.01). There were no significant differences in the elbow rotation and extension between the affected and unaffected sides ( P>0.05). All children had a Baunnman angle of 71.4°±5.4°, condylar angle of 39.9°±6.4°, and carrying angle of 8.4°±3.6°. The Mayo score for the affected elbow was 90.1±4.8 points, and 38 graded 95 points and above. Complications included superficial infection of the screw channel in 14 cases, and mild postoperative re-displacement in 1 case. Epiphysiodesis, elbow eversion deformity, delayed union, and non-union were not reported. According to the characteristics of ultrasound images of 38 children, the acceptable standards for closed reduction were judged at four levels, including the parallel articular surface of the coronal plane, vertical articular surface of the coronal plane, vertical articular surface of the sagittal plane, and vertical articular surface of the posterior lateral sagittal plane.
ConclusionsUltrasound-guided closed reduction and Kirschner wire fixation of unstable humeral lateral condyle fractures offer the advantages of minimal intraoperative blood loss, minimal radiation, and good short-term follow-up effect. It is feasible to determine the acceptable criteria for closed reduction by ultrasound at four scans.
姚杰,刘朝宇,贾国强,等. 超声引导下闭合复位克氏针固定治疗不稳定型肱骨外髁骨折[J]. 中华小儿外科杂志,2025,46(03)：250-255.
DOI:10.3760/cma.j.cn421158-20230727-00200版权归中华医学会所有。
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