| 经皮撬拨联合改良带针旋转复位法零切开治疗极度失稳GartlandⅣ型儿童肱骨髁上骨折 |
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投稿时间：2023-08-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 孙强 |
SUN Qiang |
四川省骨科医院儿童骨科, 四川 成都 610041 |
Department of Pediatric Orthopedics, Sichuan Orthopaedic Hospital, Chengdu 610041, Sichuan, China |
2357401669@qq.com |
| 周英 |
ZHOU Ying |
四川省骨科医院儿童骨科, 四川 成都 610041 |
Department of Pediatric Orthopedics, Sichuan Orthopaedic Hospital, Chengdu 610041, Sichuan, China |
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| 陈伟 |
CHEN Wei |
四川省骨科医院儿童骨科, 四川 成都 610041 |
Department of Pediatric Orthopedics, Sichuan Orthopaedic Hospital, Chengdu 610041, Sichuan, China |
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| 任波 |
REN Bo |
四川省骨科医院儿童骨科, 四川 成都 610041 |
Department of Pediatric Orthopedics, Sichuan Orthopaedic Hospital, Chengdu 610041, Sichuan, China |
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| 刘兴坤 |
LIU Xing-kun |
四川省骨科医院急诊科, 四川 成都 610041 |
Emergency Department, Sichuan Orthopaedic Hospital, Chengdu 610041, Sichuan, China |
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| 期刊信息：《中国骨伤》2025年，第38卷，第1期，第92-96页 |
| DOI：10.12200/j.issn.1003-0034.20230481 |
| 基金项目:2023年成都市卫生健康委员会医学科研课题(编号:2023450);四川省中医药管理局四川省名中医周英工作室活态传承建设项目[编号:(2022)16号] |
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中文摘要:
目的: 研究经皮撬拨联合改良带针旋转复位法治疗Gartland Ⅳ型儿童肱骨髁上骨折的临床疗效，评价术后肘关节功能、肘内翻畸形率及此技术的应用前景。
方法: 收集2020年6月至2023年1月共98例Gartland Ⅳ型儿童肱骨髁上骨折患者作为研究对象，其中男57例，女41例;年龄2~14(6.24±4.76)岁;左侧48例，右侧50例;受伤至手术时间为2 h~2 d，其中急诊手术26例。术中先运用杠杆原理，将克氏针钝性插入骨折断端，行经皮撬拨复位。再采用改良带针旋转复位法闭合复位克氏针内固定，均做到零切开。采用Flynn评分对术后6个月肘关节的功能和外观进行评价。
结果: 98例患儿均顺利完成手术，并获随访，时间6~14(9.82±3.51)个月，骨折断端均骨性愈合，时间6~8(6.72±1.17)周。术后6个月肘关节Flynn功能评分:优95例，良3例。无相关并发症发生，如肘内翻畸形、骨筋膜间室综合征、克氏针断裂及排异反应、医源性血管神经损伤、Volkmann挛缩和骨化性肌炎。
结论: 经皮撬拨联合改良带针旋转复位法治疗极度失稳Gartland Ⅳ型儿童肱骨髁上骨折具有零切开、创伤小、安全和疗效好，最大限度减少手术创伤和瘢痕形成等优势，术后肘关节功能恢复好。 |
| 【关键词】肱骨髁上骨折 Gartland Ⅳ型 极度失稳 撬拨复位 改良带针旋转 内固定 |
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| Zero-incision treatment of supracondylar humeral fractures in extremely unstable Gartland type Ⅳ children by percutaneous prying combined with modified rotary reduction with Kirschner wire |
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ABSTRACT
Objective To investigate the clinical efficacy of percutaneous prying combined with modified rotary reduction with needle in the treatment of supracondylar fracture of humerus in Gartland type Ⅳ children,and to evaluate the postoperative elbow joint function,the incidence of elbow varus deformity and the application prospect of this technique.
Methods A total of 98 children diagnosed with Gartland type Ⅳ supracondylar humeral fractures between June 2020 and January 2023 were included in this study,comprising of 57 males and 41 females. The age ranged from 2 to 14 years old with an average of (6.24±4.76) years old. There were 48 cases on the left side and 50 on the right side. The time interval from injury to surgery ranged from 2 hours to 2 days,and emergency operation was performed in 26 cases. During the operation,the Kirschner wire was inserted bluntly into the broken end of the fracture using the lever principle,and the reduction was performed by percutaneous prying. Then the modified rotary reduction method with kirschner wire was used to close and reset the Kirschner wire internal fixation,and zero incision was achieved in all cases. Flynn score was used to evaluatal the function and appearance of the elbow joint at 6 months after operation.
Results The operation was successfully completed by all 98 children,and they were followed up for a duration from 6 to 14 months with an average of (9.82±3.51) months. The fractures in all cases healed,the time ranged from 6 to 8 weeks with an average of (6.72±1.17) weeks. The Flynn function score of the elbow joint was rated as excellent in 95 cases and good in 3 cases at the 6-month postoperative evaluation. No related complications occurred,such as cubitus varus deformity,osteofascial compartment syndrome,Kirschner wire rupture or rejection,iatrogenic vascular and nerve injury,Volkmann's contracture or ossification myositis.
Conclusion Percutaneous pry extraction combined with modified rotary reduction with needle in the treatment of humeral supracondylar fracture in extremely instability Gartland type Ⅳ children has the advantages of zero incision,little trauma,safety and good efficacy,and minimization of surgical trauma and scar formation. The postoperative elbow joint function recovery is good. |
| KEY WORDS Humerus supracondylar fuacture Gartland type Ⅳ Extreme instability Joystick reduction Midified ratary reduction with Kirschner wire Internal fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙强,周英,陈伟,任波,刘兴坤.经皮撬拨联合改良带针旋转复位法零切开治疗极度失稳GartlandⅣ型儿童肱骨髁上骨折[J].中国骨伤,2025,38(1):92~96 |
| 英文格式: | SUN Qiang,ZHOU Ying,CHEN Wei,REN Bo,LIU Xing-kun.Zero-incision treatment of supracondylar humeral fractures in extremely unstable Gartland type Ⅳ children by percutaneous prying combined with modified rotary reduction with Kirschner wire[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(1):92~96 |
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