Guo Meizhen, Xie Yan, Su Yuxi
Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders.
China International Science and Technology Cooperation Base of Child Development and Critical Disorders, The Children's Hospital of Chongqing Medical University.
J Pediatr Orthop. 2020 Sep;40(8):e703-e707. doi: 10.1097/BPO.0000000000001518.
The standard treatment for supracondylar humeral fractures (SHFs) in children is closed reduction and percutaneous Kirschner (K)-wire fixation. In patients who present >14 days after injury and show callus formation, this procedure cannot be performed. There are 2 options in these cases: functional exercises with osteotomy performed at a later stage if cubitus varus is present, or immediate open reduction and percutaneous K-wire fixation. This study aimed to evaluate the outcomes of K-wire fixation through an anterior approach in children with neglected SHF and identify factors predicting the outcomes.
This retrospective study assessed the files of 32 children treated for neglected SHF at our hospital between June 2015 and May 2018. An incision was made along the anterior transverse groove of the elbow. The callus was removed, the fracture was reduced, and K-wire fixation was performed. The outcome evaluation included the radiological Baumann angle, pin fixation construct, carrying angles, and the functional outcome was Mayo Elbow Performance Score and Flynn criteria. Binary regression analysis compared the functional outcome as the dependent variable with age, time from injury to operation, operation time, and the amount of callus.
The interval between injury and operation was 14 to 40 days (average, 22.4 d). Patients were followed for 12 to 36 months (average, 21.5 mo). Fracture healing took 5 to 8 weeks (average, 6.6 wk). No patient had a vascular injury or compartment syndrome. Twelve patients were intraoperatively assessed for radial and median nerve injury. No nerve repair was required. All nerve injuries recovered within 3 months. No iatrogenic ulnar nerve injury occurred. One patient had an infected incision. Binary regression analysis showed that the time elapsed between injury and operation (P=0.033) and Gartland type (P=0.008) were inversely correlated with outcomes; the longer the duration, the poorer the outcomes.
The functional outcomes after open reduction and K-wire fixation through an anterior approach were poorer with longer time to surgery and Gartland type.
Level III.
儿童肱骨髁上骨折（SHF）的标准治疗方法是闭合复位和经皮克氏（K）针固定。对于受伤超过14天且出现骨痂形成的患者，无法进行该手术。在这些情况下有两种选择：如果存在肘内翻，则进行功能锻炼并在后期进行截骨术；或者立即进行切开复位和经皮K针固定。本研究旨在评估采用前路克氏针固定治疗被忽视的儿童SHF的疗效，并确定预测疗效的因素。
这项回顾性研究评估了2015年6月至2018年5月在我院接受治疗的32例被忽视的SHF患儿的病历。沿肘部前横沟做切口。去除骨痂，复位骨折，并进行克氏针固定。疗效评估包括放射学鲍曼角、钢针固定结构、提携角，功能疗效采用梅奥肘关节功能评分和弗林标准。二元回归分析将功能疗效作为因变量，与年龄、受伤至手术时间、手术时间和骨痂量进行比较。
受伤至手术的间隔时间为14至40天（平均22.4天）。患者随访12至36个月（平均21.5个月）。骨折愈合时间为5至8周（平均6.6周）。无患者发生血管损伤或骨筋膜室综合征。12例患者术中评估桡神经和正中神经损伤情况。无需进行神经修复。所有神经损伤均在3个月内恢复。未发生医源性尺神经损伤。1例患者切口感染。二元回归分析显示，受伤至手术的时间（P=0.033）和加特兰分型（P=0.008）与疗效呈负相关；时间越长，疗效越差。
手术时间越长，加特兰分型越严重，前路切开复位和克氏针固定后的功能疗效越差。
三级。
