外髁交叉克氏针固定稳定儿童肱骨髁上骨折B角的临床意义

目的：评价经皮外髁交叉克氏针固定治疗伸直型肱骨髁上骨折对稳定Bauman角,防止肘内翻发生的临床意义。方法：85例儿童肱骨髁上骨折,分为经皮外髁交叉克氏针固定（A组40例）、经皮内外侧交叉克氏针固定（B组29例）、切开复位内固定（C组16例）3组进行治疗,测量各组不同阶段Bauman角的变化及肘内翻发生率。结果：85例均获得1~5年随访。各组复位前与复位后、去固定后的Baumann角比较P〈0.01。复位术后与去固定的Baumann角比较P〉0.05,去固定后A、B组,B、C组比较P〈0.05,A、C组比较P〉0.05。肘内翻总发生率5.88%;,A组仅为2.5%;其中A、B组,A、C组比较P〈0.05,B、C组比较P〉0.05。结论：经皮外髁交叉克氏针固定组各阶段Baumann角均小于对照组,肘内翻发生率低,且不易损伤血管神经,是一种安全、有效,微创的治疗手段。

Lateral Condylar Crossing Kirschner Wire Fixation for Stabilizing Bauman Angle in the Supracondylar Fracture of the Humerus in Children

Objective：To evaluate the clinical significance of percutaneous lateral condylar crossing Kirschner wire fixation for stabilizing Bauman angle in the supracondylar fracture of the humerus in children.Methods：A total of 85 children with supracondylar fracture of the humerus were assigned to group A（40 cases with percutaneous lateral condylar crossing Kirschner wire fixation） or group B（29 cases with percutaneous lateral and medial crossing Kirschner wiere fixation） or group C（16 cases with open reduction and internal fixation）.Bauman Angle changes at different time periods and incidence of cubitus varus were recorded.Results：All subjects were followed up for 1 to 5 years.There were significant differences among the three groups in Bauman angle value before and after reduction and removal of fixation（P0.01）,but there was no significant difference in Bauman angle value after reduction and removal of fixation in three groups（P0.05）.Remarkable difference was found between the three groups after removal of fixation（P0.05）.Incidence of cubitus varus in general was 5.88%,and was 2.5% in group A.For the 5 cases of nerve damage before the treatment,one of them suffered from mild claw fingers,and the other 4 cases restored.After surgery,2 cases in group B and C underwent ulnar nerve stimulation,but the symptoms disappeared after removing the wire.Conclusion：Treated with percutaneous lateral condylar crossing Kirschner wire fixation,the changes in Baumann Angle of each phase are smaller than the control groups,with low incidence of cubitus varus and nerve and vessel damages,which proves to be a safe,effective,and minimally invasive treatment.