Babal Jessica C, Mehlman Charles T, Klein Guy
Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Pediatr Orthop. 2010 Apr-May;30(3):253-63. doi: 10.1097/BPO.0b013e3181d213a6.
Supracondylar fractures of the humerus are the most common type of elbow fracture in children. Of all complications associated with supracondylar fractures, nerve injury ranks highest, although reports of the incidence of specific neurapraxia vary. This meta-analysis aims primarily to determine the risk of traumatic neurapraxia in extension-type supracondylar fractures as compared with that of flexion-type fractures; secondarily it aims to use subgroup analysis to assess the risk of iatrogenic neurapraxia induced by pin fixation.
A literature search identified studies that reported the incidence of nerve injury presenting with displaced supracondylar fractures of the humerus in children. Meta-analysis was subsequently performed to evaluate the risk of traumatic neurapraxia associated with supracondylar fractures. Subgroup analysis of included articles was additionally performed to assess the risk of iatrogenic neurapraxia associated with lateral-only or medial/lateral pin fixation.
Data from 5148 patients with 5154 fractures were pooled for meta-analysis. Among these patients, traumatic neurapraxia occurred at a weighted event rate of 11.3%. Anterior interosseous nerve injury predominated in extension-type fractures, representing 34.1% of associated neurapraxias; meanwhile, ulnar neuropathy occurred most frequently in flexion-type injuries, representing 91.3% of associated neurapraxias. Nerve injury induced by lateral-only pinning occurred at a weighted event rate of 3.4%, while the introduction of a medial pin elicited neurapraxia at a weighted event rate of 4.1%. Lateral pinning carried increased risk of median neuropathy, whereas the use of a medial pin significantly increased the risk of ulnar nerve injury.
Of nerve injury associated with extension-type fractures, anterior interosseous neurapraxia ranks highest, whereas of flexion-type neuropathy, ulnar nerve injury predominates. We confirm that medial pinning carries the greater overall risk of nerve injury as compared with lateral-only pinning and that the ulnar nerve is at risk of injury in medially pinned patients. We additionally suggest that lateral pinning carries neurapraxic risk with respect to the median nerve.
Level IV; Meta-analysis.
肱骨髁上骨折是儿童最常见的肘部骨折类型。在与肱骨髁上骨折相关的所有并发症中，神经损伤最为常见，尽管关于特定神经失用症发生率的报道各不相同。本荟萃分析主要旨在确定伸直型肱骨髁上骨折与屈曲型骨折相比发生创伤性神经失用症的风险；其次，旨在通过亚组分析评估克氏针固定引起医源性神经失用症的风险。
通过文献检索确定了报告儿童肱骨髁上移位骨折伴发神经损伤发生率的研究。随后进行荟萃分析以评估与肱骨髁上骨折相关的创伤性神经失用症风险。另外对纳入文章进行亚组分析，以评估与单纯外侧或内侧/外侧克氏针固定相关的医源性神经失用症风险。
汇总了5148例患者5154处骨折的数据进行荟萃分析。在这些患者中，创伤性神经失用症的加权事件发生率为11.3%。伸直型骨折中以前臂骨间神经损伤为主，占相关神经失用症的34.1%；同时，尺神经病变在屈曲型损伤中最常见，占相关神经失用症的91.3%。单纯外侧克氏针固定引起的神经损伤加权事件发生率为3.4%，而内侧克氏针引起神经失用症的加权事件发生率为4.1%。外侧克氏针固定增加了正中神经病变的风险，而使用内侧克氏针显著增加了尺神经损伤的风险。
在与伸直型骨折相关的神经损伤中，前臂骨间神经失用症最为常见，而在屈曲型神经病变中，尺神经损伤为主。我们证实，与单纯外侧克氏针固定相比，内侧克氏针固定总体上导致神经损伤的风险更大，并且内侧克氏针固定的患者尺神经有损伤风险。我们还表明，外侧克氏针固定存在正中神经失用症风险。
四级；荟萃分析。
