| 超声引导下手法复位经皮交叉穿针固定治疗儿童移位型肱骨髁上骨折 |
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投稿时间：2019-12-21
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| 作者 | Author | 单位 | Address | E-Mail |
| 徐文斌 |
XU Wen-bin |
浙江中医药大学附属江南医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 戴蓉丹 |
DAI Rong-dan |
浙江中医药大学附属江南医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 刘悦 |
LIU Yue |
浙江中医药大学附属江南医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 钟辉 |
ZHONG Hui |
浙江中医药大学附属江南医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
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| 庄伟 |
ZHUANG Wei |
浙江中医药大学附属江南医院, 浙江 杭州 311201 |
Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China |
994397598@qq.com |
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| 期刊信息：《中国骨伤》2020年，第33卷，第10期，第907-911页 |
| DOI：10.12200/j.issn.1003-0034.2020.10.004 |
| 基金项目:浙江省中医药科技计划项目（编号：2019ZB108） |
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中文摘要:
目的：探讨利用超声技术引导复位以及探查尺神经位置，经皮交叉穿针固定治疗移位型儿童肱骨髁上骨折的临床疗效。
方法：回顾性分析2017年12月至2018年12月收治的45例移位型肱骨髁上骨折手术患儿的临床资料，其中男26例，女19例；年龄1岁3个月～11岁4个月，平均7.6岁；摔倒伤44例，坠落伤1例；左侧29例，右侧16例；GartlandⅡ型12例，Ⅲ型33例；受伤至手术时间4 h～7 d，平均2.5 d；患儿均无神经及血管损伤。利用超声对患儿骨折复位进行引导，并行交叉穿针固定，其中内侧穿针时，使用超声探测尺神经位置以避免损伤尺神经。术中观测尺神经状态，末次随访时采用Flynn临床功能评定标准对患儿肘关节功能及美观度进行评价，并观察术后并发症情况。
结果：术中使用超声分别从肱尺关节内侧面、肱桡关节外侧面以及肱尺关节矢状面3个方向对骨折端进行探查，可指导骨折复位，并可清楚探查尺神经位置，避免内侧穿针时出现尺神经损伤。患儿术后均获得随访，时间6～12个月，平均9个月。术后未出现复位丢失，骨折均愈合，愈合时间4～6周，平均5周。末次随访时根据Flynn评估标准：同健侧相比，41例患侧屈伸受限0°～5°，临床评定为优；3例屈伸受限6°～10°，临床评定为良；1例屈伸受限11°～15°，临床评定为可。同健侧相比，40例患侧提携角丢失0°～5°，临床评定为优；5例提携角丢失6°～10°，临床评定为良。术后均未出现尺神经损伤、肘内外翻畸形等并发症。
结论：虽然目前超声引导治疗移位型儿童肱骨髁上骨折对操作者有较高要求，但其具有对软组织可清晰显影、便携、有效、对健康无影响等优点，在术中可清晰探查骨折情况，引导骨折复位，并可准确显示尺神经位置，有效提高内侧穿针安全性，从而最大程度减少并发症的发生。因此，超声引导手法复位经皮交叉穿针固定治疗移位型儿童肱骨髁上骨折有效且值得进一步推广。 |
| 【关键词】超声外科手术 肱骨骨折 骨折固定术,内 儿童 |
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| Ultrasound-guided reduction and percutaneous crossed pin fixation for the treatment of displaced supracondylar fracture of the humerus in children |
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ABSTRACT
Objective: To investigate the effect of ultrasound-guided reduction and exploration of ulnar nerve position and percutaneous crossed pin fixation for the treatment of displaced supracondylar fracture of the humerus in children.
Methods: The clinical data of 45 patients with displaced supracondylar fracture of humerus from December 2017 to December 2018 were analyzed retrospectively,including 26 boys and 19 girls,ranging in age from 1 year and 3 months to 11 years and 4 months,with an average of 7.6 years old;44 cases of crashing injury,1 case of falling injury;29 cases on the left side,16 cases on the right side;12 patients classified to Gartland typeⅡand 33 patients classified to Gartland type Ⅲ. The operation was performed from 4 h to 7 d after injury,with an average of 2.5 d. There were no neurological and vascular injuries occurred in the children. Ultrasound was used to guide the fracture reduction of the child,and the cross-needle was fixed. In the medial needle insertion,the ulnar nerve position was detected by ultrasound to avoid damage to the ulnar nerve. The ulnar nerve state was observed during operation. The clinical function evaluation criteria of Flynn was used at the latest follow-up. The evaluation criteria was used to evaluate the functional and aesthetic characteristics of the elbow joints of the children,and to observe the complications such as ulnar nerve injury after operation.
Results: Ultrasound was used to detect the fracture from the medial side of the elbow,the lateral aspect of the elbow and the sagittal plane of the elbow. The position of the ulnar nerve could be clearly explored to avoid ulnar nerve injury when the needle was inserted inside. All children were followed up,and the duration ranged from 6 to 12 months,with an average of 9 months. None of the patients had a loss of repositioning and the fractures healed. The healing time ranged from 4 to 6 weeks,with an average of 5 weeks. At the latest follow-up,according to Flynn's evaluation criteria:compared with the healthy side,41 patients with flexion and extension limitation were 0° to 5°,clinically evaluated as excellent;3 patients with flexion and extension limitation were 6° to 10°,clinically evaluated as good;1 patient with flexion and extension limitation was 11° to 15°,clinically evaluated as acceptable. Compared with the healthy side,40 patients lost 0° to 5°of the angle,and 5 patients lost 6° to 10°of the angle. There were no complications such as ulnar nerve injury and cubitus varus.
Conclusion: Although ultrasound-guided treatment of displaced supracondylar fracture of the humerus in children has higher requirements for the operator at present,because of its advantages of clear development,portability,effectiveness and no impact on health,it could clearly explore the fracture situation during the operation,guide the reduction of the fracture,and accurately show the position of the ulnar nerve,effectively improve the safety of the medial puncture,so as to minimize the complications The occurrence of the disease. Therefore,the treatment of displaced supracondylar fracture of humerus with ultrasound-guided manual reduction and percutaneous cross needle fixation is effective and worthy of further promotion. |
| KEY WORDS Ultrasonic surgical procedures Humeral fractures Fracture fixation,internal Child |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 徐文斌,戴蓉丹,刘悦,钟辉,庄伟.超声引导下手法复位经皮交叉穿针固定治疗儿童移位型肱骨髁上骨折[J].中国骨伤,2020,33(10):907~911 |
| 英文格式: | XU Wen-bin,DAI Rong-dan,LIU Yue,ZHONG Hui,ZHUANG Wei.Ultrasound-guided reduction and percutaneous crossed pin fixation for the treatment of displaced supracondylar fracture of the humerus in children[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(10):907~911 |
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