儿童Gartland Ⅲ型肱骨髁上骨折克氏针外侧进针的疗效

 目的 探讨外侧进针方式对克氏针治疗Gartland Ⅲ型儿童肱骨髁上骨折疗效的影响。方法 回顾性分析北京儿童医院2017-02至2019-02收治并采用外侧平行克氏针和外侧扇形克氏针两种进针方式的138例Gartland Ⅲ型儿童肱骨髁上骨折病例资料,其中平行组为外侧平行克氏针固定(65例),扇形组为外侧扇形克氏针固定(73例)。评估两组间的临床特征、末次随访的功能及外观评分,并进行统计学分析。结果 共134例获得随访,随访时间6~24个月(平均16个月)。两组病例临床特征无统计学差异,术后根据Flynn功能标准,平行组优良率为93.7%,扇形组优良率为90.3%,差异无统计学意义;根据Flynn美观标准,平行组优良率为92.1%,扇形组优良率为90.1%,差异无统计学意义。所有病例术后未出现骨折再移位、医源性神经损伤、肘内翻等并发症。结论 对于GartlandⅢ型儿童肱骨髁上骨折,克氏针外侧平行与外侧扇形两种进针方式均能取得良好的手术效果及预后。

Outcome analysis of lateral pinning for Gartland Ⅲ supracondylar fractures in children

Objective To evaluate the efficacy of lateral divergent or parallel pin fixation using smooth K-wires for the operative management of Gartland type Ⅲ supracondylar humerus fractures in children. Methods A retrospective analysis of 138 cases of Gartland type Ⅲ supracondylar humeral fractures treated in Beijing Children’s Hospital between February 2017 to February 2019 was conducted. According to fixation methods, the patients were divided into the lateral divergent pin fixation group and the lateral parallel pin fixation group. The clinical features of the two groups and Flynn scores at the last follow-up were compared and analyzed statistically. Results A total of 134 patients were followed up for 6-24 months (mean 16 months). There was no significant difference in clinical characteristics between the two groups. Postoperative evaluation was conducted by Flynn standards. By Flynn’s function standard, the excellent and good rate of parallel group was 93.7%, compared to 90.3% in the divergent group, with no statistically significant difference. By Flynn’s aesthetic standards, the excellent and good rate of the parallel group was 92.1%, and that of the divergent group was 90.1%, so there was no significant difference between the two groups. There were no complications, such as fracture redisplacement, latrogenic nerve injury or cubitus varus. Conclusions Our series demonstrates that both lateral divergent and parallel pin fixations are effective and safe approaches to Gartland type Ⅲ supracondylar humerus fractures in children.