儿童肱骨远端干骺端-骨干交界处无粉碎性骨折的固定：克氏针还是弹性髓内钉，如何抉择？
Fixation for metaphyseal-diaphyseal junction noncomminuted fracture of the distal humerus in children: K-wire or ESIN, how to decide?
作者信息
Li Minglei, Liu Tianjing, Li Qiwei, Li Lianyong, Zhang Lijun, Shi Liwei, Wang Enbo
机构信息
Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.
出版信息
Front Pediatr. 2025 Aug 6;13:1640764. doi: 10.3389/fped.2025.1640764. eCollection 2025.
BACKGROUND
The metaphyseal-diaphyseal junction (MDJ) fracture of the distal humerus has posed significant difficulty clinically, as the increased height of the distal fragmant makes it hard for Kirschner wires to reach the proximal fragment. Our previous study provided suggestions for the choice of fixation in metaphyseal-diaphyseal junction (MDJ) fracture of the distal humerus according to the location of the fracture line based on biomechanical analysis. This study went on to testify an advanced suggestions in clinical patients.
METHODS
Normal elbow x-rays were measured to get a normal reference value to define the location of the fracture. A ratio of c' (the diameter of humeral shaft at the most proximal point of the fracture line)/d (the diameter of humeral shaft at distal humerus) was used to define the location of the fracture and guide the selection of fixation. According to our previous research, the ratio of c'/d was used to define the location of the fracture. Eighty-nine patients with MDJ fractures were included. For patients with high MDJ fracture elastic stable intramedullary nails (ESIN) were selected and for those with low MDJ fractures Kirschner wires were used. The short-term outcome was assessed using the Flynn criteria.
RESULTS
The c/d ratio of 1.2 was finally used to define the high or low location of the fracture. All the 89 MDJ fractures healed uneventfully. 73 of them were fixed with lateral or crossed pinning and 84.9% of them were ranked as excellent. 16 cases were fixed with ESIN and 81.3% were excellent. There were no significant difference between the outcomes of the groups.
CONCLUSIONS
ESINs were used for fractures in the higher part of the MDJ region, defined as c'/d < 1.2. Three lateral divergent or crossed pins were used for fractures in the lower part of the MDJ region with c'/d ≥ 1.2. This strategy, as recommended by our previous biomechanical research, has been demonstrated to be practical in clinical practice.
LEVEL OF EVIDENCE
Level III retrospective cohort study.
背景
肱骨远端干骺端-骨干交界处（MDJ）骨折在临床上造成了很大困难，因为远端骨折块高度增加使得克氏针难以到达近端骨折块。我们之前的研究基于生物力学分析，根据骨折线位置为肱骨远端干骺端-骨干交界处（MDJ）骨折的固定选择提供了建议。本研究继续在临床患者中验证这一先进建议。
方法
测量正常肘部X线片以获得正常参考值来定义骨折位置。使用c'（骨折线最近端处肱骨干直径）/d（肱骨远端肱骨干直径）的比值来定义骨折位置并指导固定选择。根据我们之前的研究，c'/d比值用于定义骨折位置。纳入89例MDJ骨折患者。对于高位MDJ骨折患者选择弹性稳定髓内钉（ESIN），对于低位MDJ骨折患者使用克氏针。使用弗林标准评估短期结果。
结果
最终使用1.2的c/d比值来定义骨折的高位或低位。所有89例MDJ骨折均顺利愈合。其中73例采用外侧或交叉穿针固定，84.9%评为优秀。16例采用ESIN固定，81.3%为优秀。两组结果之间无显著差异。
结论
对于MDJ区域较高部位（定义为c'/d < 1.2）的骨折使用ESIN。对于MDJ区域较低部位（c'/d≥1.2）的骨折使用三根外侧发散或交叉的克氏针。正如我们之前生物力学研究所推荐的，这一策略已被证明在临床实践中是可行的。
证据水平
III级回顾性队列研究。
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