摘要
目的 观察肘关节镜辅助内侧铰链优先复位联合内固定治疗儿童肱骨外髁Song Ⅴ型骨折的疗效.方法 回顾性分析自2020-04-2021-12采用肘关节镜辅助内侧铰链优先复位联合内固定治疗的20例儿童肱骨外髁Song Ⅴ型骨折.将关节镜置入关节腔并充盈关节腔,观察骨折线方向,寻找内侧铰链位置后再将前臂旋后,极度伸腕伸指,通过操作入路将探针辅助骨折块复位,复位后可见骨折块与内侧铰链处仍存在较大缝隙,此时减少水压,推挤复位,将1枚直径1.5 mm的克氏针固定于内侧铰链处,关节镜下可见骨折面复位良好,但是仍存在微小缝隙,再继续置入1枚空心钉固定加压骨折块,收紧缝隙.结果 20例均获门诊复查或电话随访,随访时间13～30个月,平均16.3个月.切口长度5～8 mm,平均5.9 mm;术中出血量1～5 mL,平均2.8 mL;手术时间40～230 min,平均128 min,住院时间2～6d,平均3.8 d;内固定去除时间26～114 d,平均69.3 d.患儿术后肘关节活动均得到完全恢复,末次随访肘关节活动度均无异常.Dhillon肘关节功能评分:优20例,优良率100％.无骨折延迟愈合及不愈合,无肘内翻、肘外翻,无神经并发症,无骨化性肌炎以及感染等并发症.结论 采用关节镜下辅助复位联合克氏针结合空心钉内固定治疗肱骨外髁Song Ⅴ型骨折,疗效满意,具有微创、解剖复位、内固定可靠、术后关节功能好、并发症少等特点,该技术值得在临床中推广应用.
Abstract
Objective To evaluate the effect of arthroscopic assisted reduction and internal fixation for the treatment of Song type Ⅴ external condylar fractures of humerus in children.Methods The data of 20 cases of Song type Ⅴ humeral lateral con-dyle fractures treated with arthroscopic reduction and internal fixation from April 2020 to December 2021 were analyzed retro-spectively.There were 13 males and 7 females.The mean age of injury was 4.7 years(1-9 years).The length of incision,the days of hospitalization,the amount of bleeding during operation,the length of operation,the imaging results,the elbow function score at the last follow-up and the postoperative complications were recorded.Results All patients were followed up for an av-erage of 16.3 months(13-30 months),with an average incision length of 5.9 cm(5-8 cm),an average hospital stay of 3.8 days(2-6 days),and an average intraoperative blood loss of 2.8 ml(1-5 mL).The mean operative time was 128 minutes(40-230 min-utes),and the mean fixation removal time was 69.3 days(26-114 days).The average time of fracture healing was 6.1 weeks(4-8 weeks).Dhillon evaluation of elbow function score:excellent in 20 cases,the excellent and good rate 100％.There were no de-layed union,nonunion,cubitus varus,cubitus valgus,nerve complication,myositis ossificans and infection.Conclusion Ar-throscopic reduction combined with internal fixation with Kirschner wire and cannulated screw for the treatment of Song Ⅴ frac-tures of the lateral condyle of humerus,it has the characteristics of minimal invasion,anatomic reduction,reliable internal fixa-tion,good postoperative joint function and less complications,and is worthy of wide clinical application.
基金项目
深圳市医疗卫生三名工程项目(SZSM202011012)
NETL
NSTL
万方数据