肱骨髁上骨折后力学改变与畸形愈合的相关性研究

目的 研究肱骨髁上骨折后力学改变畸形愈合的相关性。方法 研究对象选取2019年至2022年在我院就诊的54例肱骨髁上骨折患儿，所有患者均采取闭合复位克氏针固定术，将随访6个月时并发肘外翻和肘内翻的患儿分为畸形愈合组（n=10），未发生并发肘外翻和肘内翻的患儿分为正常愈合组（n=44），比较2组患儿术前、复位后、随访6个月时的肱骨小头前倾角、Baumann角、提携角、肱骨远端扭转角，采用Spearman相关系数分析术前、复位后、随访6个月时提携角与肱骨小头前倾角、Baumann角、肱骨远端扭转角的相关性。采用logistic回归分析影响肘关节畸形愈合的力学因素。结果 术前畸形愈合组中Baumann角、肱骨远端扭转角、提携角均明显高于正常愈合组，差异均有统计学意义（P<0.05）；复位后，畸形愈合组肱骨小头倾角、Baumann角、肱骨远端扭转角明显高于正常愈合组，差异均有统计学意义（P<0.05）;Spearman相关性分析结果显示，两组术前Baumann角与肱骨远端扭转角与提携角呈明显负相关（P<0.05）；复位后，两组的肱骨小头倾角、Baumann角、肱骨远端扭转角与...     

儿童肱骨髁上骨折移位程度与Baumann角关系的分析研究

目的:应用Excel软件对小儿肱骨髁上骨折的桡尺侧移位值和Baumann角进行数值拟合分析,得出相关数据曲线,以期用于指导临床小儿肱骨髁上骨折治疗。方法:收集2010年7月至2011年7月间就诊的小儿肱骨髁上骨折病例56例(年龄3～14岁;男34例,女22例;桡偏型15例,尺偏型41例)。采用数据测量工具MB-Ruler,测量各病例X线片骨折的移位值及Baumann角,将数值录入于Excel,分别对56组骨折的移位值和Baumann角,以及15组桡偏型、41组尺偏型数值行拟合分析,并对所得数据曲线进行分析。结果:用2种方式进行拟合所得出结果相近,即尺偏切线斜率>桡偏切线斜率;当桡偏系数<-0.18,尺偏系数>0.50时,Baumann角有反向改变的趋势,即Baumann角变化范围在65.70°～96.77°;当尺偏系数≥0.15时,Baumann角≥82°。结论:小儿肱骨髁上骨折尺偏移位对Baumann角的影响大于桡偏移位,当尺偏系数≥0.15时应注重纠正,预防肘内翻发生。     

Baumann角的放射学测量及其临床意义

测定了４８例２－１３岁正常小儿及７１例肱骨髁上骨折小儿的Ｂａｕｍａｎｎ角。结果提示Ｂａｕｍａｎｎ角与提携角之间存在非常显著的相关性，骨折复位后Ｂａｕｍａｎｎ角可用来准确地预测提携角，并有效地防止肘内翻畸形的发生。     

操纵杆辅助闭合复位治疗儿童不可复性肱骨髁上骨折

目的探讨操纵杆辅助闭合复位治疗儿童不可复性肱骨髁上骨折的安全性及有效性。方法收集我院2016年1月至2018年10月收治的GartlandⅢ型肱骨髁上骨折645例,其中不可复性肱骨髁上骨折32例,14例采用"挤牛奶"手法后闭合复位获得成功,其余18例采用经肘关节后侧撬拨闭合复位成功,其中2例失访,获得完整随访16例。男12例,女4例;年龄3～12岁,平均(7.31±2.44)岁。术前合并正中神经症状7例,桡动脉搏动消失4例。复查随访术后X线片,记录末次随访Baumann角、提携角与健侧对比,末次随访采用Flynn肘关节功能评分进行功能评估。结果 16例随访时间4～13个月,平均(7.8±2.6)个月。健侧Baumann角与患侧术后Baumann角进行Shpiro-Wilk正态性检验,结果提示符合正态分布(健侧P=0.37,患侧术后P=0.64),进行参数配对t检验(P=0.17),提示健侧与患侧术后Baumann角差异无统计学意义。同样方法进行健侧提携角并与患侧提携角统计学检验(P=1.00),差异无统计学意义。采用Flynn肘关节功能评分,优9例,良6例,中1例,优良率占93.75%。结论经肱三头肌后侧"操纵杆"复位技术可以作为闭合复位"不可复性"肱骨髁上骨折复位方法有效补充及辅助,在术后早期临床研究中安全有效。     

屈肘前臂旋前位整复伸直型小儿肱骨髁上骨折的疗效观察

目的应用SPSS和EXCEL对小儿肱骨髁上骨折整复前后的桡尺侧移位值和Baumann角进行回归分析,以评价屈肘前臂旋前位整复伸直型小儿肱骨髁上骨折的疗效。方法收集2010年7月至2011年7月间,就诊的小儿肱骨髁上骨折56例,采用数据侧量工具MB-Ruler,测量各病例受伤后X线片骨折的移位值及Baumann角,将数值录入于Excel。然后使用屈肘前臂旋前位手法整复,摄片后同手法整复前处理,数据录入Excel。将数据分为4组：1整复前尺偏型;2整复后尺偏型;3整复前桡偏型;4整复后桡偏型。分别使用SPSS行回归分析,在EXCEL上合并拟合曲线进行对比分析。结果对比整复前后尺偏型骨折的情况得出,整复后尺偏型骨折减少了11例,尺偏系数较小了0.493,Baumann角减少了21°,且改变同样量的尺偏系数的情况下,整复后Baumann角度的变化量下降,稳定性增强。对比手法整复前后桡偏型骨折情况类似,桡偏系数减小,Baumann角减小,变化率下降,稳定性增高。结论屈肘前臂旋前位整复小儿肱骨髁上骨折减少尺偏病例,控制偏移距离,减小Baumann角,增强断端稳定性,可以有效地控制肘内翻畸形的发生。     

三种复位方法对Gartland Ⅱ型和Ⅲ型儿童肱骨髁上骨折的近期疗效及肘内翻畸形的影响

目的:探讨三种复位方法(手法复位石膏外固定、切开复位克氏钉内固定、手法复位经皮克氏钉内固定)对Gartland Ⅱ～Ⅲ型儿童肱骨髁上骨折的近期疗效及肘内翻畸形的影响。方法:回顾性分析2017年1月-2019年5月笔者医院收治的166例Gartland Ⅱ～Ⅲ型儿童肱骨髁上骨折患儿。根据患儿的固定复位治疗方案分为3组,50例患儿采用手法复位石膏外固定纳入A组,61例患儿采用切开复位克氏钉内固定纳入B组,55例患儿采用手法复位经皮克氏钉内固定纳入C组。比较三组患儿的骨折愈合时间、肘关节屈伸功能、Baumann角和提携角、肘内翻畸形发生率。结果:三组患儿骨折愈合时间比较差异无统计学意义(P0.05)。B、C两组患儿的肘关节屈伸功能均优于A组、Baumann角均小于A组,提携角均大于A组,差异均有统计学意义(P0.05)。B、C两组患儿的肘内翻畸形发生率分别为8.20%和7.27%,均小于A组的22.00%,差异有统计学意义(P0.05)。B组和C组的肘关节屈伸功能程度、Baumann角和提携角、肘内翻畸形发生率比较差异均无统计学意义(P0.05)。结论:Gartland Ⅱ～Ⅲ型儿童肱骨髁上骨折采用克氏钉内固定效果优于石膏外固定,对患儿肘关节屈伸功能受限和肘内翻畸形的影响较小,克氏钉内固定选用切开复位还是手法复位疗效相当。     

Baumann角测定在儿童肱骨髁上骨折的应用

肱骨髁上骨折系指肱骨远端内外骨髁上方2～3cm骨折。是儿童骨折中比较常见的疾病。而肘内翻畸形也称“枪托（Gunstock）畸形”．是其最常发生的远期并发症．献报道其平均发生率为30％．高达57％。自2001年5月至2005年5月共收治儿童肱骨髁上骨折96例．应用Baumann角（简称B角）与提携角（简称C角）的负相关性进行临床指导．取得一定的临床疗效。现总结如下。     

儿童肱骨髁上骨折复位判断指标系统在克氏针内固定术中的综合应用

[目的]探讨闭合或切开复位克氏针内固定治疗儿童肱骨髁上骨折手术中骨折复位判断指标系统的应用及效果。[方法]建立儿童肱骨髁上骨折复位判断指标系统,包括Baumann角(B角)、肱骨小头前倾角、肱骨皮质前线、骨折端间隙;在C型臂X线机透视下,闭合或切开复位骨折,测量并纠正患侧Baumann角(B角)、肱骨小头前倾角、肱骨皮质前线、骨折端间隙,以达到骨折解剖复位,避免远折端内倾。克氏针固定治疗儿童肱骨髁上骨折85例。其中男48例,女37例;年龄(3.5~12.5)岁,平均6.3岁,伸直尺偏型50例,伸直桡偏型32例,屈曲型3例。[结果]平均随访时间18.5个月。最后一次随访测患侧B角为(73.8±5.6)°,健侧为(72.8±5.9)°;提携角(C角)患侧平均(8.2±5.2)°,健侧平均(10.2±5.7)°。9例C角减少(5~10°),其中3例发生轻度肘内翻。无1例C角减少超过10°,无肘外翻畸形,未出现Volkmann挛缩及尺神经的医源性损伤。根据Flynn评价优良率为97.8%。[结论]应用肱骨髁上骨折复位判断指标系统,可完全纠正骨折的各向移位及骨折远端的尺侧移位和内倾,结合克氏针内固定,可避免骨折畸形愈合,恢复良好的肘关节功能。     

闭合和切开复位克氏针内固定治疗儿童肱骨髁上Gart-landⅡB、Ⅲ型骨折的疗效比较

目的探讨闭合复位和切开复位克氏针内固定治疗儿童肱骨髁上GartlandⅡB、Ⅲ型骨折的临床疗效。方法将79例肱骨髁上骨折患儿按治疗方法不同分为两组:闭合组(39例)行闭合复位克氏针经皮内固定,切开组(40例)行切开复位克氏针经皮内固定。比较两组的手术时间、术中失血量以及术后3个月时Baumann角、提携角、肘关节功能。结果手术时间:闭合组为(22.85±3.79)min,切开组为(34.22±2.78)min,差异有统计学意义(P0.001)。术中失血量:闭合组为(1.85±0.81)ml,切开组为(13.12±1.85)ml,差异有统计学意义(P0.001)。79例均获得随访,时间3~6个月。患儿均无骨折延迟愈合、医源性血管神经损伤等并发症。术后3个月时,Baumann角、提携角、肘关节功能优良率两组比较差异均无统计学意义(P0.05)。结论闭合复位与切开复位克氏针内固定治疗儿童肱骨髁上GartlandⅡB、Ⅲ型骨折术后功能恢复相似,但闭合复位创伤更小,手术时间短,术中失血少,并且不影响皮肤外观。     

儿童肱骨髁上骨折术后残留旋转畸形对术后疗效的影响分析

目的探讨儿童肱骨髁上骨折术后残留旋转畸形对术后疗效的影响。方法回顾性分析2020年1月至2021年12月福州市第二医院小儿骨科收治的453例Gartland Ⅲ型伸直型肱骨髁上骨折患者资料, 所有患者均行闭合复位克氏针固定术。根据复位情况分为2组:残留旋转畸形组(A组)69例, 男44例, 女25例;年龄(6.3±2.9)岁;术中透视正位X线片上Baumann角维持在65°～80°, 侧位X线片上肱骨前缘线通过肱骨小头前1/3, 残留部分旋转畸形, 但提携角正常(4°～23°)。解剖复位组(B组)384例, 男242例, 女142例;年龄(5.9±2.7)岁;术中透视正、侧位X线片示骨折端解剖复位。记录并比较两组患者术中透视次数、手术时间、术中提携角、术后6个月提携角和术后6个月肘关节Flynn评分。结果两组患者性别、年龄、侧别、克氏针固定时间比较差异均无统计学意义(P> 0.05), 具有可比性。所有患者术后获(6.3±2.9)个月随访。A组患者术中透视中位次数[6 (4, 6)次]少于B组[8 (6, 8)次], 手术时间中位数[20 (20, 25) min]少于B组[30...     

Supracondylar fractures of the humerus in children

Thirty-five children were evaluated at a mean of 2 years, 3 months following treatment of supracondylar fractures of the humerus. Elbow motion, clinical carrying angle, and roentgenographic measurements including Baumann's angle, humeral-ulnar angle, and metaphyseal-diaphyseal angle were determined for both the normal and the involved extremities. The humeral-ulnar angle best correlated with the final clinical carrying angle, followed by Baumann's angle and the metaphyseal-diaphyseal angle. We recommend postreduction measurement of the humeral-ulnar angle in fractures that have been surgically stabilized and Baumann's angle in those fractures treated by cast immobilization alone to determine the adequacy of reduction.     

Techniques for direct radiographic visualization during closed pinning of supracondylar humerus fractures in children

After reduction of a displaced supracondylar humerus fracture, the distal humerus must be easy to visualize; radiographic techniques in which the forearm overlaps the distal humerus make interpretation of fracture reduction difficult. Eighteen patients with displaced supracondylar humerus fractures were treated with reduction that was maintained manually with a variant of Dunlop's extension traction. This allows direct fluoroscopic evaluation of Baumann's angle, the contour of the distal humerus, the pin insertion site, and the angle of pin insertion. In young patients with a thin distal humerus and swollen elbow, the easiest pin placement may be achieved by inserting the pin on the lateral view (after the anteroposterior view confirms a satisfactory reduction).     

Supracondylar fractures of the humerus in children. A modified technique for closed pinning

Complications in the treatment of displaced supracondylar fractures of the humerus (DSFH), particularly cubitus varus, are a persistent problem. A prospective study was conducted on 20 children with DSFH, using a modified technique to reduce and pin the fracture. All fractures were treated with closed reduction and percutaneous pinning. After the fracture was internally fixed, intraoperative anteroposterior roentgenograms of each distal humerus were compared, using Baumann's angle. The reduction was accepted if Baumann's angle on the fractured extremity was within 4 degrees of that on the normal side. If the angles were not within 4 degrees, the closed reduction and percutaneous pinning was repeated. In this prospective series, all patients had a reduction to within 4 degrees of the normal side before they left the operating room. Three weeks after percutaneous pinning, the pins were removed and range of motion was begun. All patients returned for clinical and roentgenographic examination. With an average follow-up period of 17.2 months, all patients had excellent or good results. No patient developed cubitus varus deformity. Strict adherence to the guidelines of the protocol prevented cubitus varus deformity in this series of children with DSFH.     

Complications and timing of follow-up after closed reduction and percutaneous pinning of supracondylar humerus fractures: follow-up after percutaneous pinning of supracondylar humerus fractures

The purpose of this study was to evaluate the need for clinical evaluation with radiographs within 10 days of closed reduction and percutaneous pinning for the treatment of displaced supracondylar humerus fractures. Between May 1 and December 31, 2001, the authors evaluated the complications with closed reduction and percutaneous pinning of 104 displaced supracondylar humerus fractures. Fifty-two of the patients had the initial follow-up examination with radiographs 10 days or less after pinning; the other 52 patients had the initial follow-up examination with radiographs either after 10 days or on the day of pin removal. The overall complication rate for the series was 7.7% (8/104). All eight complications were in type III fractures. The early follow-up group had six complications; the late follow-up group had two complications. Baumann's angle, lateral humerocapitellar angle, and lateral rotational percentage were not significantly different between the two groups. The only variable tested that was associated with a complication was pin configuration. No association between late follow-up and complications was identified. The authors conclude that clinical and radiographic evaluation of routine displaced supracondylar humerus fractures requiring closed reduction and percutaneous pinning may be safely delayed until pin removal.     

Supracondylar Fracture of the Humerus in Children: A Long-Term Follow-up Study of 107 Cases

A total of 107 cases of supracondylar fracture of the humerus in children were examined after a follow-up period of 8 to 18 years. No serious complications were found. Conservative treatment gave good results, and open reduction was seldom indicated. Rotational displacement and displacement in the frontal or sagittal plane remodelled by the end of the growth period, whereas tilting of the distal fragment into varus or valgus remained. The position of reduction should be checked roentgenologically until bony consolidation occurs, by measuring Baumann's angle or the carrying angle, and rereductions should be performed within 2 weeks.     

Supracondylar fracture of the humerus in children. A long-term follow-up study of 107 cases

A total of 107 cases of supracondylar fracture of the humerus in children were examined after a follow-up period of 8 to 18 years. No serious complications were found. Conservative treatment gave good results, and open reduction was seldom indicated. Rotational displacement and displacement in the frontal or sagittal plane remodelled by the end of the growth period, whereas tilting of the distal fragment into varus or valgus remained. The position of reduction should be checked roentgenologically until bony consolidation occurs, by measuring Baumann's angle or the carrying angle, and rereductions should be performed within 2 weeks.     

Supracondylar fractures of the humerus. Assessment of cubitus varus by the Baumann angle

A simple method of radiological assessment has been used to measure the angle between the long axis of the humeral shaft and the growth plate of the capitellum (the Baumann angle). In the normal arm a significant relationship was found between the Baumann angle and the carrying angle. The Baumann angle was also measured after reduction of supracondylar fractures of the humerus and was found to correlate well with the final carrying angle measured at follow-up. There was no significant difference between the Baumann angle after reduction and that measured at follow-up; and it is suggested that this angle after reduction can be reliably used to predict accurately the final carrying angle.     

Closed reduction and percutaneous pinning of displaced supracondylar fractures of humerus in children with delayed presentation

Objective: Supracondylar fractures of the humerus account for 60% of all the fractures around the pediatric elbow and even in developed countries 18% of patients undergo surgery 48 hours or longer following presentation in the hospital. Management guidelines are not clear yet for these patients who present late. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 12 hours or more after injury.Methods: We reviewed the functional and radiological results of closed reduction and percutaneous pinning using crossed K-wires in 40 patients with displaced extension type supracondylar fracture of the humerus (Gartland type Ⅲ) with a delay of more than 12 hours in presentation. The average age of patients was 4.5 years and the mean delay in presentation was 17.55 hours.Results: Closed reduction and percutaneous pinning was successful in 90% of patients. The mean follow up period was 15 months. The Baumann's angle was restored within 4 degrees of the unaffected side in all patients. Use of a small medial incision in patients with severe swelling helped us avoid ulnar nerve injury. Using Flynn's criteria,38 patients (95%) had an excellent result. Two patients had mild myositis and both had a poor result. None of the patients developed cubitus varus.Conclusion: Closed reduction and crossed pinning of displaced supracondylar fractures of humerus in children is a safe and effective method even with delayed presentation.     

Quality of reduction versus timing of surgical intervention for pediatric supracondylar humerus fractures

Recent reports have shown that some displaced supracondylar humerus fractures can be treated in a delayed fashion the day following injury and complication rates will not be increased. This study determined if the quality of the reduction, as determined by restoration of Baumann's angle, is affected by surgical timing. Forty two patients ranging in age from 2 to 12 years were treated. Delayed intervention was defined as > 8 hours post-injury. Acute intervention occurred in 25 patients with a mean age of 5.5 years. Delayed intervention occurred in 17 patients with a mean age of 5.8 years. Baumann's angle was restored to within an average of 2.2 degrees of the contralateral elbow in the acute group and to within 1.2 degrees in the delayed group. Gartland type 2 fractures were more likely to be delayed in this retrospective study and these fractures showed better improvements in Baumann's angle restoration than did type 3 injuries when treated in a delayed fashion. In type 2 injuries and type 3 injuries without neurovascular compromise, delaying operations until the next morning will not compromise the quality of the reduction.     

Completely displaced supracondylar humerus fractures in children: results of open reduction versus closed reduction

 This retrospective study was performed to understand the clinical results after closed reduction and open reduction in 35 children (mean age 6.4 years) with completely displaced supracondylar fractures of the distal humerus between 1996 and 2000. Closed reduction (21 cases) was attempted, with open reduction (14 cases) indicated in irreducible cases with or without severe swelling. After an average follow-up of 22 months, according to Flynn's criteria, the results were excellent in 18, good in 12, fair in 2, and poor in 3. The satisfactory results rates were similar for closed and open reduction. The unsatisfactory results were related to the poor initial reduction and redisplacement after operation. The mean Baumann's angle was 8.7° in the closed reduction group and 6.6° in the open reduction group. None of the patients showed restricted elbow motion of more than 10°, even in two cases of hypertrophic scar in the open reduction group. Selective open reduction for displaced supracondylar fractures of the distal humerus produced as good results as closed reduction. Received: January 7, 2002 / Accepted: November 20, 2002 Offprint requests to: C-W. Oh