Yen Yi-Meng, Kocher Mininder S
Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
J Bone Joint Surg Am. 2008 Mar;90 Suppl 2 Pt 1:20-30. doi: 10.2106/JBJS.G.01337.
Closed reduction and percutaneous pin fixation is the treatment of choice for completely displaced (type-III) extension supracondylar fractures of the humerus in children, although controversy persists regarding the optimal pin-fixation technique. The purpose of this study was to compare the efficacy of lateral entry pin fixation with that of medial and lateral entry pin fixation for the operative treatment of completely displaced extension supracondylar fractures of the humerus in children.
This prospective, randomized clinical trial had sufficient power to detect a 10% difference in the rate of loss of reduction between the two groups. The techniques of lateral entry and medial and lateral entry pin fixation were standardized in terms of the pin location, the pin size, the incision and position of the elbow used for medial pin placement, and the postoperative course. The primary study end points were a major loss of reduction and iatrogenic ulnar nerve injury. Secondary study end points included radiographic measurements, clinical alignment, Flynn grade, elbow range of motion, function, and complications.
The lateral entry group (twenty-eight patients) and the medial and lateral entry group (twenty-four patients) were similar in terms of mean age, sex distribution, and preoperative displacement, comminution, and associated neurovascular status. No patient in either group had a major loss of reduction. There was no significant difference between the rates of mild loss of reduction, which occurred in six of the twenty-eight patients treated with lateral entry and one of the twenty-four treated with medial and lateral entry (p = 0.107). There were no cases of iatrogenic ulnar nerve injury in either group. There were also no significant differences (p > 0.05) between groups with respect to the Baumann angle, change in the Baumann angle, humerocapitellar angle, change in the humerocapitellar angle, Flynn grade, carrying angle, elbow flexion, elbow extension, total elbow range of motion, return to function, or complications.
With use of the specific techniques employed in this study, both lateral entry pin fixation and medial and lateral entry pin fixation are effective in the treatment of completely displaced (type-III) extension supracondylar fractures of the humerus in children.
闭合复位经皮穿针固定术是儿童肱骨完全移位（III型）伸直型髁上骨折的首选治疗方法，尽管关于最佳穿针固定技术仍存在争议。本研究的目的是比较外侧入路穿针固定与内外侧入路穿针固定治疗儿童肱骨完全移位伸直型髁上骨折的疗效。
这项前瞻性随机临床试验有足够的效力检测两组间复位丢失率10%的差异。外侧入路和内外侧入路穿针固定技术在针的位置、针的大小、内侧针置入时肘部的切口和位置以及术后过程方面进行了标准化。主要研究终点是复位严重丢失和医源性尺神经损伤。次要研究终点包括影像学测量、临床对线、弗林分级、肘关节活动范围、功能和并发症。
外侧入路组（28例患者）和内外侧入路组（24例患者）在平均年龄、性别分布以及术前移位、粉碎程度和相关神经血管状况方面相似。两组均无患者出现复位严重丢失。外侧入路治疗的28例患者中有6例发生轻度复位丢失，内外侧入路治疗的24例患者中有1例发生轻度复位丢失，两组间轻度复位丢失率无显著差异（p = 0.107）。两组均无医源性尺神经损伤病例。两组在鲍曼角、鲍曼角变化、肱头关节角、肱头关节角变化、弗林分级、提携角、肘关节屈曲、肘关节伸展、肘关节总活动范围、功能恢复或并发症方面也无显著差异（p > 0.05）。
采用本研究中使用的确切技术，外侧入路穿针固定和内外侧入路穿针固定在治疗儿童肱骨完全移位（III型）伸直型髁上骨折方面均有效。
