目的:在本研究中,我们研究了经皮戳内固定术和克氏针内固定术治疗大龄儿童不可复性肱骨髁上屈曲型骨折的疗效.
方法:这项回顾性调查包括27名儿童,包括15名男性和12名女性,年龄在10岁至3个月至14岁至11个月之间,所有患者均在创伤后一周内诊断为肱骨髁上屈曲型骨折。所有患者均在全身麻醉下进行手术。手动还原失败后,在C臂透视下,采用克氏针进行经皮穿刺复位,以实现骨折复位.成功还原后,将三条2.0mm克氏针交叉插入以固定骨折端。术后,肘关节用石膏固定在功能位置四周。
结果:门诊随访9~36个月。使用Flynn标准进行的临床功能评估将24例患者评为优秀,2一样好,和1一样公平,产生96.3%的总体疗效。无骨折再移位病例,骨折碎片坏死,或其他并发症,如骨不连,医源性神经损伤,骨化性肌炎,术后随访观察到或长期肘关节功能障碍。
结论:经皮戳复位克氏针固定技术是治疗大龄儿童肱骨不可复位屈曲型髁上骨折的一种简单可靠的方法,最小的创伤。该技术为骨折提供了实质性的稳定性,并导致关节功能的长期恢复。
OBJECTIVE: In this study, we investigated the efficacy of percutaneous poking reduction and Kirschner wire fixation in older children with irreducible supracondylar flexion-type fractures of the humerus.
METHODS: This retrospective investigation included 27 children, comprising 15 males and 12 females, aged between 10 years and 3 months to 14 years and 11 months, all diagnosed with a flexion-type supracondylar fracture of the humerus within one week of trauma. All patients underwent surgery under general anesthesia. Following unsuccessful manual reduction, percutaneous poking reduction with Kirschner wires was performed under C-arm fluoroscopy to achieve fracture reduction. Following successful reduction, three 2.0 mm Kirschner wires were inserted in a cross pattern to secure the fracture ends. Postoperatively, the elbow joint was immobilized in a functional position with a plaster cast for four weeks.
RESULTS: Follow-up in the outpatient department ranged from 9 to 36 months. Clinical functional assessment using Flynn\'s criteria rated 24 cases as excellent, 2 as good, and 1 as fair, yielding an overall efficacy of 96.3%. No cases of fracture re-displacement, fracture fragment necrosis, or other complications such as nonunion, iatrogenic nerve injury, myositis ossificans, or long-term elbow joint dysfunction were observed during the postoperative follow-up.
CONCLUSIONS: The percutaneous poking reduction and Kirschner wire fixation technique is a simple and reliable procedure for treating irreducible flexion-type supracondylar fractures of the humerus in older children, with minimal trauma. This technique offers substantial stability for the fracture and results in excellent long-term recovery of joint function.