儿童肱骨髁上骨折交叉克氏针固定：回顾性队列分析。
Crossed pinning in paediatric supracondylar humerus fractures: a retrospective cohort analysis.
机构信息
Department of Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
出版信息
Int Orthop. 2012 Sep;36(9):1893-8. doi: 10.1007/s00264-012-1582-x. Epub 2012 Jun 23.
PURPOSE
The aim of this study was to analyse the management of displaced paediatric supracondylar humerus fractures at our Level I Trauma Centre and to determine clinical and radiographic long-term results following operative treatment.
METHODS
Clinical and radiological results of 78 paediatric patients (29 female, 49 male; mean age 5.1 years) with supracondylar humerus fractures, treated from 1992 to 2004, were evaluated. Gartland's classification yielded 32 type II, 44 type III and further two flexion injuries. In all patients the follow-up period exceeded 12 months. Assessment after an average of 8.1 years (1.1-19.5) included neurovascular examination, Flynn's criteria (elbow function and carrying angle), pain, complications (infections, growth disturbances or iatrogenic nerve injuries) and measurement of the humeroulnar angle.
RESULTS
According to Flynn's criteria 73 patients (93.5 %) had a satisfactory outcome, while five (6.4 %) were graded as unsatisfactory (two due to cubitus varus and three because of limited elbow motion). The visual analogue scale (VAS) score averaged 0 (range 0-1) and the mean carrying angle measured 8.4° (-8 to 20°), compared to 10.8° on the contralateral side (2-20°). Injury-related complications yielded absent pulses in four (5.1 %), five (6.4 %) primary median, two (2.6 %) primary radial and one (1.3 %) primary ulnar nerve injury. Treatment-related complications included a secondary displacement and one iatrogenic radial nerve palsy. Based on primary nerve lesion as a dependent variable, statistical analysis showed that age had a significant influence revealing that older paediatric patients had a significantly higher risk (p = 0.02). Functional outcome as a dependent variable revealed an indirect proportion to the clinical carrying angle, achieving statistical significance (p < 0.01).
CONCLUSIONS
Crossed pinning in paediatric supracondylar humerus fractures is an effective method. Evaluation of the outcome in our study group demonstrated good results with the treatment approach described.
目的
本研究旨在分析我院Ⅰ级创伤中心小儿肱骨髁上骨折的治疗管理，并确定手术治疗后的临床和放射学长期结果。
方法
评估了 1992 年至 2004 年间收治的 78 例小儿肱骨髁上骨折患者（29 例女性，49 例男性；平均年龄 5.1 岁）的临床和放射学结果。Gartland 分类得出 32 型 II 型、44 型 III 型和另外 2 型屈曲损伤。所有患者的随访时间均超过 12 个月。平均 8.1 年后（1.1-19.5 年）进行评估，包括神经血管检查、Flynn 标准（肘部功能和携带角）、疼痛、并发症（感染、生长障碍或医源性神经损伤）以及测量肱尺角。
结果
根据 Flynn 标准，73 例（93.5%）患者的结果满意，5 例（6.4%）患者结果不满意（2 例因肘内翻，3 例因肘部活动受限）。视觉模拟评分（VAS）平均为 0（0-1），平均携带角为 8.4°（-8-20°），而对侧为 10.8°（2-20°）。与神经损伤相关的并发症包括 4 例（5.1%）无脉搏、5 例（6.4%）原发性正中神经损伤、2 例（2.6%）原发性桡神经损伤和 1 例（1.3%）原发性尺神经损伤。与治疗相关的并发症包括继发性移位和 1 例医源性桡神经麻痹。以原发性神经损伤为因变量的统计学分析表明，年龄有显著影响，表明年龄较大的小儿患者发生风险显著增加（p=0.02）。因变量为功能结果，显示与临床携带角成反比，具有统计学意义（p<0.01）。
结论
交叉克氏针固定治疗小儿肱骨髁上骨折是一种有效的方法。我们的研究组对治疗结果的评估表明，采用所描述的治疗方法取得了良好的效果。
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