Department of Orthopaedic Surgery, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China.
Department of Ultrasound, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China.
J Orthop Surg Res. 2023 Aug 11;18(1):595. doi: 10.1186/s13018-023-04075-y.
This study aims to evaluate the feasibility of using ultrasound-guided Kirschner wire or elastic intramedullary nail for fixation in the treatment of acute Monteggia fracture in children.
A retrospective analysis was conducted on 31 cases of acute Monteggia fracture in children treated with ultrasound-guided Kirschner wire or elastic intramedullary nail fixation between April 2020 and December 2022, including 14 cases of Kirschner wire fixation and 17 cases of elastic intramedullary nail fixation. During the operation, soft tissue compression and nerve and vascular injuries were explored, fracture reduction was performed under ultrasound guidance, and operation time was recorded. After the operation, X-ray examination was conducted to assess the quality of fracture reduction. At the last follow-up, the flexion, extension, pronation, and supination angles of both affected and unaffected elbow joints were measured, and the Mayo score was used to evaluate elbow joint function.
The average duration of surgery was 50.16 ± 19.21 min (ranging from 20 to 100 min). Based on the evaluation criteria for assessing reduction quality, 28 cases were deemed excellent, while 3 cases were considered good. After immobilization with long-arm cast for 4-6 weeks postoperatively, elbow and forearm rotation exercises were performed. Kirschner wires were removed after an average of 6.64 ± 0.93 weeks (ranging from 6 to 9 weeks) postoperatively, and elastic intramedullary nails were removed after an average of 5.12 ± 1.54 months (ranging from 4 to 10 months) postoperatively. The average follow-up time was 19.13 ± 11.22 months (ranging from 4 to 36 months). During the final follow-up, the affected limb's range of motion in flexion, extension, pronation, and supination was (141.16 ± 4.24)°, (4.61 ± 2.81)°, (84.52 ± 3.74)°, and (84.23 ± 3.69)°, respectively. There was no notable variance when compared to the healthy limb, which had a range of motion of (141.81 ± 2.99)°, (4.81 ± 2.50)°, (85.61 ± 3.12)°, and (85.03 ± 2.73)° (P > 0.05). The Mayo Elbow Performance index classified 29 cases as excellent and 2 cases as good.
Ultrasound-guided Kirschner wire or elastic intramedullary nail fixation can be used for the treatment of acute Monteggia fracture in children, which can explore the surrounding nerves, blood vessels, and soft tissue compression, reduce the difficulty of reduction, and cause minimal trauma. It can greatly reduce the risk of radiation exposure and complications such as vascular and nerve injury during the operation.
本研究旨在评估超声引导克氏针或弹性髓内钉固定治疗儿童急性孟氏骨折的可行性。
回顾性分析 2020 年 4 月至 2022 年 12 月期间采用超声引导克氏针或弹性髓内钉固定治疗的 31 例儿童急性孟氏骨折患者，其中克氏针固定 14 例，弹性髓内钉固定 17 例。手术中探查软组织压迫和神经血管损伤，在超声引导下进行骨折复位，记录手术时间。术后行 X 线检查评估骨折复位质量。末次随访时测量患侧和健侧肘关节屈伸、旋前和旋后角度，采用 Mayo 评分评估肘关节功能。
手术平均时间为 50.16±19.21min（20～100min）。根据评估复位质量的标准，28 例为优，3 例为良。术后采用长臂石膏固定 4～6 周，行肘关节及前臂旋转运动。克氏针平均 6.64±0.93 周（6～9 周）后取出，弹性髓内钉平均 5.12±1.54 个月（4～10 个月）后取出。平均随访时间为 19.13±11.22 个月（4～36 个月）。末次随访时，患侧肘关节屈伸、旋前、旋后活动度分别为（141.16±4.24）°、（4.61±2.81）°、（84.52±3.74）°、（84.23±3.69）°，与健侧相比差异无统计学意义（分别为 141.81±2.99）°、（4.81±2.50）°、（85.61±3.12）°、（85.03±2.73）°（P＞0.05）。Mayo 肘关节功能评分优 29 例，良 2 例。
超声引导下克氏针或弹性髓内钉固定治疗儿童急性孟氏骨折，可探查周围神经、血管和软组织压迫，降低复位难度，创伤小。可大大降低手术过程中辐射暴露和血管、神经损伤等并发症的风险。
