儿童肱骨髁上 Gartland ⅡB 型和Ⅲ型骨折：Blount 法是否有效且安全？

Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount's method effective and safe?

机构信息

Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France.

出版信息

J Shoulder Elbow Surg. 2017 Dec;26(12):2226-2231. doi: 10.1016/j.jse.2017.05.018. Epub 2017 Jul 20.

DOI:10.1016/j.jse.2017.05.018

PMID:28735846

Abstract

BACKGROUND

Blount's method is controversial for the treatment of Gartland types IIB and III supracondylar fracture of the humerus (SCFH) in children. The purpose of this study was to evaluate the clinical and radiologic outcomes and the failure and complication rates.

METHODS

All types IIB and III SCFH treated with Blount's method from 2003-2013 were included in this retrospective single-center study. Clinical assessment was performed according to Flynn criteria. Baumann angle, anteversion angle, anterior humeral line, and humeroulnar angle were measured for radiographic assessment.

RESULTS

Among 447 children with types IIB and III SCHF, 339 were treated according to Blount's method. There were 173 boys (51%), and the mean age was 6.3 years (1-14 years); 71% were type III. Mean time to surgery was 5.7 hours. According to Flynn criteria, results were satisfactory in 91% of cases. No compartment syndrome was encountered. There were 16 (4.7%) secondary displacements requiring surgical revision. Five (1.9%) children developed a cubitus varus deformity. At latest follow-up, the mean Baumann angle was 74.7° (95% confidence interval, 74.1-75.3), the mean anteversion angle was 39.9° (95% confidence interval, 39.5-40.3), the anterior humeral line was normal in 87.6% of cases, and the mean humeroulnar angle was 8.7°.

CONCLUSION

Blount's method is appropriate to manage types IIB and III SCFH, provided anatomic and stable reduction is obtained.

摘要

背景

对于儿童的 Gartland ⅡB 和 Ⅲ型肱骨髁上骨折（SCFH），Blount 法的治疗存在争议。本研究的目的是评估临床和影像学结果以及失败和并发症发生率。

方法

本回顾性单中心研究纳入了 2003 年至 2013 年间采用 Blount 法治疗的所有ⅡB 和 Ⅲ型 SCFH。临床评估根据 Flynn 标准进行。放射学评估测量 Baumann 角、前倾角、肱骨前缘线和肱尺角。

结果

在 447 例ⅡB 和 Ⅲ型 SCHF 患儿中，339 例采用 Blount 法治疗。其中男 173 例（51%），平均年龄 6.3 岁（1-14 岁）；71%为 Ⅲ型。手术时间平均为 5.7 小时。根据 Flynn 标准，91%的病例结果满意。未发生筋膜间室综合征。16 例（4.7%）需要手术矫正的二次移位。5 例（1.9%）儿童发生肘内翻畸形。末次随访时，平均 Baumann 角为 74.7°（95%置信区间，74.1-75.3），平均前倾角为 39.9°（95%置信区间，39.5-40.3），87.6%的病例肱骨前缘线正常，平均肱尺角为 8.7°。