Gaston R Glenn, Cates Taylor B, Devito Dennis, Schmitz Michael, Schrader Tim, Busch Michael, Fabregas Jorge, Rosenberg Eli, Blanco John
OrthoCarolina, Charlotte, NC 28207, USA.
J Pediatr Orthop. 2010 Dec;30(8):799-806. doi: 10.1097/BPO.0b013e3181f73d59.
The purpose of this study is to compare the efficacy of medial and lateral (crossed pin) and lateral-entry pin techniques for Gartland Type 3 supracondylar humerus fractures in children.
Six pediatric orthopaedists were divided into the 2 treatment groups (medial and lateral pins or lateral only pins) based on pre-study pinning technique preferences. Patients were randomized into 1 of the 2 pinning technique treatment groups based on which attending was on call at the time of patient presentation. One hundred and four patients met inclusion criteria. Forty-seven patients underwent lateral-entry pinning and 57 underwent crossed pinning. The 2 groups were similar with respect to age, sex, preoperative neurovascular injury, direction of fracture displacement, and timing of surgery. Outcome parameters measured included radiographic maintenance of reduction, iatrogenic neurovascular complications, and rate of infection. All radiographic measurements, and interobserver reliability, were determined by a 3 physician panel.
The results of the interobserver reliability data showed a strong correlation and this data allowed 95% confidence that a change in Baumann's angle of more than 6 degrees and humerocapitellar angle of more than 10 degrees was significant. The lateral-entry patients experienced a median absolute change of Baumann's angle of 3.7 degrees with 12 patients having greater than 6 degrees loss of reduction; whereas those in the medial and lateral-pin group saw a median change of 2.9 degrees with 10 patients having greater than 6 degrees loss of reduction. In terms of the humerocapitellar angle, the lateral-entry patients experienced a median absolute change of 4.8 degrees with 11 patients having greater than 10 degrees loss of reduction; whereas those in the medial and lateral-pin groups saw a median change of 5.1 degrees with 17 patients having greater than 10 degrees loss of reduction. There was no significant difference in infection rate between the 2 groups but 2 cases of iatrogenic neurovascular injury occurred in patients who had a medial pin placed.
We found no statistical difference in the radiographic outcomes between lateral-entry and medial and lateral-pin techniques for the management of Type 3 supracondylar fractures in children when evaluated in this prospective and surgeon-randomized trial, but 2 cases of iatrogenic injury to the ulnar nerve occurred with medially placed pins.
Level 2.
本研究旨在比较内侧和外侧（交叉克氏针）及外侧入路克氏针技术治疗儿童Gartland Ⅲ型肱骨髁上骨折的疗效。
6名小儿骨科医生根据术前克氏针固定技术偏好分为2个治疗组（内侧和外侧克氏针组或仅外侧克氏针组）。患者根据就诊时值班的主治医生被随机分为2种克氏针固定技术治疗组中的1组。104例患者符合纳入标准。47例患者接受外侧入路克氏针固定，57例接受交叉克氏针固定。两组在年龄、性别、术前神经血管损伤、骨折移位方向和手术时机方面相似。测量的结果参数包括复位的影像学维持情况、医源性神经血管并发症和感染率。所有影像学测量以及观察者间的可靠性均由一个3名医生组成的小组确定。
观察者间可靠性数据结果显示有很强的相关性，该数据使我们有95%的把握确定Baumann角变化超过6度和肱头角度变化超过10度具有显著性。外侧入路组患者Baumann角的中位绝对变化为3.7度，12例患者复位丢失超过6度；而内侧和外侧克氏针组患者的中位变化为2.9度，10例患者复位丢失超过6度。就肱头角度而言，外侧入路组患者的中位绝对变化为4.8度，11例患者复位丢失超过10度；而内侧和外侧克氏针组患者的中位变化为5.1度，17例患者复位丢失超过10度。两组感染率无显著差异，但在内侧放置克氏针的患者中发生了2例医源性神经血管损伤。
在这项前瞻性、医生随机试验中评估时，我们发现外侧入路与内侧和外侧克氏针技术治疗儿童Ⅲ型髁上骨折的影像学结果无统计学差异，但内侧放置克氏针时有2例发生尺神经医源性损伤。
2级。
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