儿童肱骨髁上骨折：闭合复位与经皮克氏针固定的疗效。

Supracondylar Humerus Fractures in Older Children: Success of Closed Reduction and Percutaneous Pinning.

机构信息

Division of Pediatric Orthopaedics.

Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto ON, Canada.

出版信息

J Pediatr Orthop. 2021 Apr 1;41(4):242-248. doi: 10.1097/BPO.0000000000001732.

DOI:10.1097/BPO.0000000000001732

PMID:33655902

Abstract

BACKGROUND

The incidence of supracondylar humerus (SCH) fracture declines and fracture types change as children grow. Optimal treatment method is unclear in older children. The aim of the study was to determine if fracture type and configuration of distal humerus fractures changes as patients approach skeletal maturity, and to assess the success of closed reduction and percutaneous pin (CRPP) in extra-articular SCH fractures in this transitional age group.

METHODS

Inclusion criteria for this retrospective review were (1) distal humerus fractures with extension types 2 and 3, flexion type, T-type; (2) surgically managed, and (3) modified Sauvegrain score ≥1. Reviewed parameters included fracture type and configuration, grade of skeletal maturity, fixation technique, and loss of reduction. Primary analysis was to determine the distribution of fracture type and configuration with age or grade of skeletal maturity. Secondary analysis was used to determine the factors affecting treatment success of CRPP in extra-articular fractures.

RESULTS

A total of 142 patients were included (58 males and 84 females). Fracture types revealed significant changes with increased age (P=0.031) and skeletal maturity grade (P<0.005). Skeletal maturity was a better predictor of changing fracture type than chronological age. T-type fractures were only seen in patients with modified Sauvegrain score ≥6 and flexion-type fractures were only seen in patients with modified Sauvegrain score ≤4. Loss of reduction rate after CRPP was 5%. The success of CRPP was not affected by age, sex, modified Sauvegrain score, fracture type, direction of displacement, coronal fracture pattern, number of pins or medial pin use. Fracture obliquity in the sagittal plane (P=0.05), suboptimal pin spread (P<0.01), and lack of bicolumnar fixation (P<0.01) were found as statistically significant factors associated with failed CRPP.

CONCLUSION

The distribution of fracture type changed with increased age and skeletal maturity. CRPP of extra-articular fractures in older children is a reliable option regardless of the stage of skeletal maturity. Determinants of a good outcome include optimal pinning technique with adequate pin spread at the fracture site and bicolumnar fixation.

LEVEL OF EVIDENCE

Level IV-retrospective case series.

摘要

背景

随着儿童的成长，肱骨髁上（SCH）骨折的发病率下降，骨折类型也发生变化。对于较大的儿童，最佳治疗方法尚不清楚。本研究的目的是确定随着患者接近骨骼成熟度，远端肱骨骨折的类型和配置是否会发生变化，并评估在这个过渡年龄段，经皮闭合复位和经皮针（CRPP）治疗关节外 SCH 骨折的成功率。

方法

本回顾性研究的纳入标准为（1）伸展型 2 型和 3 型、屈曲型、T 型的远端肱骨骨折；（2）手术治疗；（3）改良 Sauvegrain 评分≥1。评估的参数包括骨折类型和形态、骨骼成熟度分级、固定技术和复位丢失。主要分析是确定骨折类型和形态随年龄或骨骼成熟度分级的分布。次要分析用于确定影响关节外骨折 CRPP 治疗成功的因素。

结果

共纳入 142 例患者（男 58 例，女 84 例）。随着年龄（P=0.031）和骨骼成熟度分级（P<0.005）的增加，骨折类型发生了显著变化。骨骼成熟度是预测骨折类型变化的更好指标，而非实际年龄。仅在改良 Sauvegrain 评分≥6 的患者中可见 T 型骨折，仅在改良 Sauvegrain 评分≤4 的患者中可见屈曲型骨折。CRPP 后复位丢失率为 5%。CRPP 的成功率不受年龄、性别、改良 Sauvegrain 评分、骨折类型、移位方向、冠状面骨折模式、针的数量或内侧针使用的影响。矢状面骨折倾斜（P=0.05）、针的扩散不理想（P<0.01）和缺乏双柱固定（P<0.01）被认为是与 CRPP 失败相关的统计学显著因素。