儿童JacobⅢ型肱骨外髁骨折经皮与开放克氏针固定比较

Kirschner wire fixation of Jacob type III lateral humeral condylar fracture by closed versus open reduction in children

摘要:

[目的] 探究经皮穿针内固定治疗儿童Jacob Ⅲ型肱骨外髁骨折（lateral humeral condylar fracture, LHCF） 的临床结果。[方法] 回顾性分析本院2020 年12 月—2022 年8 月采用克氏针固定Jacob Ⅲ型LHCF 的37 例患儿的临床资料。依据术前医患沟通结果，19 例采用闭合复位经皮穿针内固定（经皮组），另外18 例采用切开复位内固定（开放组）。比较两组围手术期、随访及影像资料。[结果] 37 例患儿均顺利完成手术，术中无严重神经、血管损伤等并发症。经皮组在术中出血量[(11.3±0.4) ml vs (67.9±2.0) ml, P＜0.001]、手术时间[(39.2±6.1) min vs (68.4±7.7) min, P＜0.001] 及住院时间[(6.3±0.1) d vs (13.5±0.2) d, P＜0.001] 均显著优于开放组，但是经皮组术中透视次数显著多于开放组[(8.6±1.2) 次vs (4.0±1.1) 次, P＜0.001]；两组的术后外固定时间及切口愈合等级的差异均无统计学意义（P＞0.05）。两组患儿随访9~15 个月，平均（12.3±0.3） 个月，两组患儿恢复完全负重活动时间及末次随访Flynn 评级的差异均无统计学意义（P＞0.05）。随时间推移，两组患儿VAS 评分及MEPS 评分均显著改善（P＜0.05）。术后1 d，经皮组VAS 评分[(4.6±1.0) 分vs (6.9±0.9) 分, P＜0.001] 显著优于开放组，其余相应时间点两组VAS评分及MEPS 评分比较差异无统计学意义（P＞0.05）。术后影像评估，两组骨折复位质量、骨折愈合时间、提携角及SCA 比较差异无统计学意义（P＞0.05）。复查X 线片示两组骨折均愈合，无内固定松动、断裂等。[结论] 经皮穿针内固定术治疗儿童JacobⅢ型肱骨外髁骨折，手术时间短、出血量少、无需切口，术后疼痛轻，有利于患儿骨折早日恢复。

Abstract:

[Objective] To evaluated clinical consequences of closed reduction and percutaneous Kirschner wire fixation of Jacob typeIII lateral humeral condylar fracture (LHCF) in children. [Method] A retrospective research was conducted on 37 children who had Jacobtype III LHCF fixed with Kirschner wires in our hospital from December 2020 to August 2022. Based on preoperative communication be-tween doctors and patients, 19 children received closed reduction and percutaneous Kirschner wire fixation (the CRPF group), while other18 patients were treated by open reduction and internal fixation with Kirschner wire (the ORIF group). The documents regarding to perioper-ative period, follow-up, and images were compared between the two groups. [Result] All patients in both groups had operation performedsuccessfully without any serious complications, such as neurological or vascular damage during the operation. The CRPF group proved sig-nificantly superior to the ORIF group in terms of intraoperative bleeding [(11.3±0.4) ml vs (67.9±2.0) ml, P＜0.001], operation time [(39.2±6.1) min vs (68.4±7.7) min, P＜0.001], and hospital stay [(6.3±0.1) days vs (13.5±0.2) days, P＜0.001], while the CRPF group consumed sig-nificantly greater number of intraoperative fluoroscopy than the ORIF group [(8.6±1.2) times vs (4.0±1.1) times, P＜0.001]. There was no sta-tistically significant difference in time of postoperative external fixation time and incision healing grade between the two groups (P＞0.05).All patients in both groups were followed up for 9~15 months, with an average of (12.3±0.3) months. There were no statistically significantdifferences in time to regain full weight-bearing activity and Flynn scale at the latest follow-up between the two groups of patients (P＞0.05). The VAS score and MEPS score significantly improved in both groups over time (P＜0.05). The CRPF group was significantly betterthan the ORIF group in VAS one day after surgery [(4.6±1.0) vs (6.9±0.9), P＜0.001], despite of the fact that there was no statistically signifi-cant difference in VAS score and MEPS score between the two groups at the remaining time points (P＞0.05). As for radiology, there was nosignificant difference in fracture reduction quality, fracture healing time, carrying angle and SCA between the two groups (P＞0.05), and allchildren in both groups had fractures healed without any loosening or fracture of internal fixation at the latest follow-up. [Conclusion]Closed reduction and percutaneous Kirschner wire fixation of Jacob type III lateral humeral condylar fracture in children has the advantag-es of shortening surgical time, minimizing bleeding, no need for incision, relieveing postoperative pain, and is beneficial for early recoveryof the fracture in children.