Patriota Gyoguevara Sol Queiroz Andrade, Assunção Filho Carlos Alberto, Assunção Carlos Alberto
Hospital Manoel Victorino, Serviço de Ortopedia e Traumatologia, Salvador, BA, Brazil.
Hospital Regional de Santo Antonio de Jesus, Serviço de Ortopedia e Traumatologia, Santo Antônio de Jesus, BA, Brazil.
Rev Bras Ortop. 2017 Jun 7;52(4):428-434. doi: 10.1016/j.rboe.2017.05.013. eCollection 2017 Jun-Jul.
To define the best technique for the surgical treatment of supracondylar fracture of the humerus (SFH) in children, evaluating percutaneous pinning with side wires cross-pinning.
Randomized controlled trials using the Medline, CAPES, and BIREME. The criteria for inclusion of articles criteria were: (1) randomized controlled trials (RCTs) comparing percutaneous wire fixation techniques, (2) SFH Gartland II B, III, and IV, and (3) children aged 1-14 years. The following were used as main variables: incidence of iatrogenic injury to the ulnar nerve and loss reduction.
Eight studies were selected (521 patients) comparing surgical treatment with pinning in supracondylar fracture of the humerus in children Gartland II type B, III or IV. Iatrogenic injury to the ulnar nerve was greater with the cross-pinning technique, with RR 0.28 and = 0.03, while the mini-open technique presented RR 0.14 and = 0.2. A statistically significant greater loss of reduction in the lateral pinning was observed in FSU Gartland III and IV( = 0.04).
Based upon this meta-analysis of prospective randomized clinical trials, the following is recommended: (1) percutaneous pinning with lateral wires in supracondylar fractures of the humerus in children classified as Gartland II type B; (2) use of crossed wires for Gartland type III or IV, using the mini-open technique for the medial wire.
确定儿童肱骨髁上骨折（SFH）手术治疗的最佳技术，评估侧方钢丝交叉穿针的经皮穿针固定术。
使用Medline、CAPES和BIREME进行随机对照试验。纳入文章的标准为：（1）比较经皮钢丝固定技术的随机对照试验（RCT）；（2）Gartland II B型、III型和IV型SFH；（3）1 - 14岁儿童。以下作为主要变量：尺神经医源性损伤的发生率和复位丢失情况。
选择了8项研究（521例患者），比较儿童Gartland II B型、III型或IV型肱骨髁上骨折的手术穿针固定治疗。交叉穿针技术导致尺神经医源性损伤的发生率更高，相对危险度（RR）为0.28，P = 0.03，而微创技术的RR为0.14，P = 0.2。在Gartland III型和IV型骨折中，观察到外侧穿针固定复位丢失在统计学上有显著增加（P = 0.04）。
基于这项前瞻性随机临床试验的荟萃分析，建议如下：（1）对于分类为Gartland II B型的儿童肱骨髁上骨折，采用侧方钢丝经皮穿针固定；（2）对于Gartland III型或IV型骨折，使用交叉钢丝，内侧钢丝采用微创技术。
