Baumann角在儿童肱骨髁上骨折经皮固定术中的临床应用

目的闭合复位,经皮克氏针固定治疗儿童肱骨髁上骨折手术中应用Baumann角(B角)及评价其疗效。方法在C臂X线机透视下,闭合复位骨折的三维移位,测量并纠正患侧B角,X线片证实与健侧B角之差≤4°。经皮克氏针固定治疗儿童肱骨髁上骨折97例。其中男59例,女38例;年龄2.5～13.5岁,平均6.8岁,伸直尺偏型57例,伸直桡偏型38例,屈曲型2例。结果97例平均随访时间34.5个月。B角患侧平均为73.7°,健侧平均72.8°;提携角(C角)患侧平均7.6°,健侧平均9.7°,其中12例发生C角减少5°～10°、其中5例发生轻度肘内翻,根据Flynn评价均为优87.6%、良12.4%。肘关节伸屈功能平均为-6.5°(伸)138°(屈),优良率为97.9%。克氏针固定时损伤尺神经1例,未出现Volkmann挛缩。结论整复时强调完全纠正尺偏移位及内倾,B角恢复满意后,采用经皮克氏针固定,固定可靠,能避免肘内翻,可提前功能锻炼时间,不需极度屈肘外固定,能防止前臂Volkmann挛缩的发生,肘关节功能恢复满意。

Clinical significance of Baumann's angle in the percutaneous pinning fixation for supracondylar fractures of the humerus in children

Objective To evaluate the clinical significance of Baumann's angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children. Methods There were 97 children (male 59, female 38, mean age of 6.8 years) with displaced supracondylar fractures of the humerus were treated in this hospital. Under fluoroscopy guidance, three-dimensional displacement of fractures was corrected by closed reduction. The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann's angle was less than 4 degree compared to that on the normal side. All of them were followed up for 34.5 months (range, 12 to 48 months). Results There was one case with ulnar nerve palsy associated with the pinning. There were no Volkmann's contracture in this group. X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side. An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography. Five patients developed slight cubitus varus deformity. The results according to Flynn criteria were excellent in 85 patients ( 87.6%), good in 12 patients ( 12.4%). Conclusions The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baunann angle and percutaneous pinning fixation.