儿童肱骨外侧髁骨折采用可吸收螺钉和可吸收缝线切开复位内固定的回顾性研究
Retrospective study of open reduction and internal fixation of lateral humeral condyle fractures with absorbable screws and absorbable sutures in children.
作者信息
Su Yuxi, Chen Kai, Qin Jiaqiang
机构信息
Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University.
Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Medicine (Baltimore). 2019 Nov;98(44):e17850. doi: 10.1097/MD.0000000000017850.
BACKGROUND
Lateral humeral condyle fractures are the second most common elbow fracture in children. Displaced and rotated fractures require stabilization and reduction. Kirschner wires (K-wires) are most commonly used in the fixation of these fractures. Here, we introduce a new fixation method that uses an absorbable screw. We aim to determine if it is feasible to treat lateral humeral condyle fractures with an absorbable screw by comparing functional outcomes following absorbable screw fixation vs. K-wire fixation.
METHODS
Between May 2007 and September 2010, 86 patients were treated with absorbable screws (43 patients) or K-wire (43 patients). All patients had been diagnosed with lateral condyle fractures that were classified as either Jacob type II (unstable) or III. One absorbable screw (3.5 mm-diameter) was used for fixation in 1 group, while two 1.6 to 1.8 mm K-wires were used in the other group. Patients were followed 6 months about the elbow function according to Broberg and Morrey standard. On 5-7 years, the patients were followed about the carrying angle (valgus deformities and varus deformities), range of motion (flexion loss and extension loss), prominent lateral condyle, symptomatic implants, and fishtail deformity.
RESULTS
Anatomic reduction was achieved in all patients. Each group had one radial nerve injury that were present preoperatively. Nerve function recovered spontaneously within 3 to 4 weeks of surgery in both patients. No patient developed necrosis of the capitulum in both groups. Nine patients in K-wires group and 2 in absorbable screw group developed symptomatic implants (P = .048). On the sixth month, there was no significant difference on elbow function according to Broberg and Morrey standard. On 5 to 7 years (average, 6.7 ± 1.3 years), valgus deformities was 6.8 ± 1.2 vs 5.7 ± 0.8, varus deformities was 7.2 ± 1.5 vs 5.1 ± 1.9, flexion loss was 12.4 ± 2.2 vs 9.5 ± 3.1, extension loss was 11.1 ± 3.1 vs 10.2 ± 2.7, prominent lateral condyle was 27.9% vs 37.2%, fishtail deformity was 7.3% vs 4.9%, no significant difference between these groups.
CONCLUSIONS
Open reduction with absorbable screw fixation is feasible and safe for the treatment of lateral condyle fractures of the humerus in children.
LEVEL OF EVIDENCE
Therapeutic III.
背景
肱骨外侧髁骨折是儿童第二常见的肘部骨折。移位和旋转骨折需要稳定和复位。克氏针（K 针）是这些骨折固定中最常用的方法。在此，我们介绍一种使用可吸收螺钉的新固定方法。我们旨在通过比较可吸收螺钉固定与 K 针固定后的功能结果，确定用可吸收螺钉治疗肱骨外侧髁骨折是否可行。
方法
2007 年 5 月至 2010 年 9 月期间，86 例患者接受了可吸收螺钉治疗（43 例）或 K 针治疗（43 例）。所有患者均被诊断为外侧髁骨折，分为雅各布 II 型（不稳定）或 III 型。一组使用一枚 3.5 毫米直径的可吸收螺钉进行固定，另一组使用两枚 1.6 至 1.8 毫米的 K 针。根据布罗伯格和莫里标准对患者的肘部功能进行 6 个月的随访。在 5 - 7 年时，对患者的提携角（外翻畸形和内翻畸形）、活动范围（屈曲丧失和伸展丧失）、外侧髁突出、有症状的植入物以及鱼尾状畸形进行随访。
结果
所有患者均实现解剖复位。每组各有 1 例患者术前存在桡神经损伤。两名患者的神经功能均在术后 3 至 4 周内自发恢复。两组均无患者出现肱骨小头坏死。K 针组有 9 例患者和可吸收螺钉组有 2 例患者出现有症状的植入物（P = 0.048）。在第六个月时，根据布罗伯格和莫里标准，两组肘部功能无显著差异。在 5 至 7 年（平均 6.7 ± 1.3 年）时，外翻畸形分别为 6.8 ± 1.2 与 5.7 ± 0.8，内翻畸形分别为 7.2 ± 1.5 与 5.1 ± 1.9，屈曲丧失分别为 12.4 ± 2.2 与 9.5 ± 3.1，伸展丧失分别为 11.1 ± 3.1 与 10.2 ± 2.7，外侧髁突出分别为 27.9%与 37.2%，鱼尾状畸形分别为 7.3%与 4.9%，两组之间无显著差异。
结论
可吸收螺钉切开复位固定治疗儿童肱骨外侧髁骨折是可行且安全的。
证据级别
治疗性 III 级。
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