超声“镜像”引导闭合复位克氏针内固定在儿童Song Ⅴ型肱骨外髁骨折治疗中的应用

doi:10.3760/cma.j.cn101202-20230910-00075

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摘要目的探讨超声“镜像”引导闭合复位经皮克氏针内固定治疗儿童SongⅤ型肱骨外髁骨折的临床疗效。方法病例系列报告。纳入2019年1月—2022年1月安徽省儿童医院收治的42例SongⅤ型肱骨外髁骨折患儿的临床资料,其中男29例、女13例,年龄1.2~10.2（4.8±1.6）岁,左侧27例、右侧15例。术前采集健侧肱骨远端矢状面和横断面超声影像作为标准影像,术中在超声引导下行骨折闭合复位经皮克氏针内固定,并以健侧肱骨远端标准影像为参照,验证骨折复位情况。观察指标：（1）观察患儿手术时间、术后住院时间,以及住院期间有无患肢肿胀加重、活动疼痛、末梢血运受阻、钉眼渗出、感染等情况;（2）术后定期随访,观察患儿骨折愈合情况,以及有无侧骨突形成、骨不连、延迟愈合、畸形愈合及针尾激惹、伤口深部组织感染、神经损伤等并发症;（3）术后6个月采用Flynn肘关节评分标准评估肘关节功能。结果 42例患儿均顺利完成手术,术后即刻X线检查显示均获解剖复位。手术时间16~87（48.1±19.9）min,术中出血量2~10（5.5±1.9）mL。术后2例患儿患肢肿胀严重,3例患儿患肢钉眼渗出严重,均予相应处理后好转。患儿术后患肢末梢血运佳、手指活动可。术后住院时间2~5（3.4±1.0）d。42例患儿均获随访,随访时间10~26（16.8±4.2）个月。随访期间12例患儿侧骨突形成,但随时间延长较前好转;3例发生针尾激惹,拔除克氏针石膏继续固定。患儿骨折均愈合,愈合时间6~8（6.4±0.7）周。随访期间,患儿均未发生伤口深部组织感染、神经损伤、骨不连、延迟愈合、畸形愈合等严重并发症。术后6个月肘关节功能优37例、良5例,优良率100%。结论超声“镜像”引导下闭合复位经皮克氏针内固定治疗儿童Song Ⅴ型肱骨外髁骨折微创、安全,术中骨折复位效果好,术后患儿肘关节功能恢复好,值得推广应用。

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	李洋洋
	马海龙
	刘方
	张思成
	华中托
	孙军

关键词 ：肱骨骨折, 超声检查, 多普勒, 彩色, 骨折固定术, 内, 闭合复位术, 儿童

Abstract：Objective This study aimed to investigate the clinical effect of closed reduction guided and percutaneous Kirschner wire (K-wire) fixation by ultrasonic "mirror image" in the treatment of Song V external humeral fracture in children. Methods This study included a series of case reports. The clinical data of 42 child patients with Song V external humeral fracture admitted to Anhui Children's Hospital from January 2019 to January 2022 were retrospectively analyzed. Among them, 29 were males and 13 were females. The mean age was 1.2-10.2 (4.8±1.6) years. Twenty-seven child patients were on the left side, and 15 child patients were on the right side. Preoperative sagittal and cross-section ultrasound images of the healthy distal humerus were taken as the standard image. During the operation, closed fracture reduction and percutaneous K-wire fixation were performed under ultrasound guidance. The standard image of the healthy distal humerus was used as the reference to verify fracture reduction. Observation indicators: (1) The operation time and postoperative hospital stay of the children were observed, as well as whether the swelling of the affected limb was aggravated, whether the activity was painful, whether the peripheral blood circulation was blocked, and whether nail eye exudation and infection were detected during hospitalization. (2) The children were followed up regularly after surgery to observe the fracture healing; whether lateral bony process formation, bone nonunion, delayed bone union, and malunion occurred; and whether complications such as pintail irritation, wound deep tissue infection, and nerve injury developed. (3) The Flynn elbow was used to evaluate elbow joint function six months after surgery. Results This operation was successfully performed in 42 child patients and they were anatomically reduced by X-ray examination immediately after the operation. The operative time was 16-87 (48.1±19.9) minutes, and the intraoperative blood loss was 2-10 (5.5±1.9) mL. Two child patients exhibited severe swelling of the affected limb, and three child patients had severe exudation of the nail eye of the affected limb. All were treated and improved. After surgery, the blood flow of the affected extremity was good, the finger movement of the affected extremity was satisfactory, and no deep infection or bone non-union occurred. Postoperative hospital stay was 2-5 (3.4±1.0) days. All 42 child patients were followed up for 10 to 26 (16.8±4.2) months. During follow-up, lateral osteophytes formed in 12 child patients, but the patients were better than before with the extension of time. Needle tail irritation occurred in three child patients, and K-wire was removed and continued fixation was performed. All fractures healed, and the mean healing time was 6-8 (6.4±0.7) weeks. During the follow-up period, no serious complications such as wound deep tissue infection, bone nonunion, delayed bone union, malunion, or nerve injury occurred. The Flynn function score of elbow joint was used to evaluate elbow joint function six months after surgery; 37 child patients of were excellent, and 5 child patients were good, with an excellent and good rate of 100%. Conclusion Closed reduction and percutaneous K-wire fixation under ultrasonic "mirror image" guidance for the treatment of Song V external humerus fracture in children is minimally invasive and safe, and which has a good intraoperative fracture reduction effect, and ensures good postoperative recovery of elbow joint function in children, thus being worthy of popularization and application.

Key words： Humeral fractures Ultrasonography Dopper color Fracture fixation internal Close reduction Child

收稿日期: 2023-09-10

基金资助:国家自然科学基金（U19A2057）; 安徽省自然科学基金（2208085QH241）; 安徽省卫生健康科研项目（AHWJ2022b008）; 安徽医科大学校基金青年科学基金（2022xkj112）; 安徽省儿童医院科研项目（21etyy002、21ety012）

通讯作者: 孙军,Email：Sunjun500@aliyun.com

引用本文:

李洋洋, 马海龙, 刘方, 张思成, 华中托, 孙军. 超声“镜像”引导闭合复位克氏针内固定在儿童Song Ⅴ型肱骨外髁骨折治疗中的应用[J]. 中华解剖与临床杂志, 2024, 29(4): 244-248.
Li Yangyang, Ma Hailong, Liu Fang, Zhang Sicheng, Hua Zhongtuo, Sun Jun. Application of ultrasonic "mirror image"-guided closed reduction and Kirschner wire internal fixation in the treatment of Song V external humeral fractures in children. Chinese Journal of Anatomy and Clinics, 2024, 29(4): 244-248.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20230910-00075 或 http://www.cjac.com.cn/CN/Y2024/V29/I4/244

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