Objective: To compare the effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children.
Methods: The clinical data of 94 children with unstable humeral lateralcondylar fractures admitted to three medical centers between January 2021 and October 2022 were retrospectively analyzed. The children were divided into three groups according to the Song classification and whether the elbow joint was dislocated or not, including 42 cases of Song 4 type (group A), 38 cases of Song 5 type (group B), and 14 cases of elbow joint dislocation (group C). There was no significant difference in gender, age, side, cause of injury, and time from injury to operation among the three groups ( P>0.05). All children were treated with ultrasound-guided closed reduction and Kirschner wire fixation. The operation time and complications of the three groups were recorded and compared, and the failure of closed reduction was evaluated by ultrasound. X-ray examination was performed at last follow-up to measure the Baumann angle, condylar angle, carrying angle, and lateral osteophyte of the affected side; the extension, flexion, pronation, and supination range of motion of the affected elbow joint were measured; the function of the elbow joint was evaluated by Mayo score.
Results: The operation time in group A was significantly longer than that in groups B and C ( P<0.05). There were 7, 2, and 5 cases of closed reduction failure in groups A, B, and C, respectively, and there was no significant difference in the incidence of the closed reduction failure ( P>0.05). All patients were followed up 6-28 months, with an average of 15.7 months. There was no significant difference in the follow-up time among the three groups ( P>0.05). Complications: in group A, there were 2 cases of delayed union, 4 cases of needle tract infection, 1 case of trochlear necrosis, and 39 cases of lateral osteophyte; in group B, there was 1 case of malunion, 5 cases of needle tract infection, 1 case of redisplacement, and 26 cases of lateral osteophyte; in group C, there were 2 cases of needle tract infection and 10 cases of lateral osteophyte. There was no significant difference in the incidence of complications among the three groups ( P>0.05). No cubitus varus or cubitus valgus deformity was found in all patients. At last follow-up, except that the condylar angle in group A was significantly greater than that in groups B and C ( P<0.05), there was no significant difference in other imaging indicators, elbow range of motion, or Mayo score between groups ( P>0.05).
Conclusion: The Song type 4 of humeral lateralcondylar fracture treated with ultrasound-guided closed reduction and Kirschner wire fixation has a longer operation time, more postoperative complications, and is more prone to lateral osteophyte.
目的: 探讨超声引导下闭合复位克氏针固定治疗不同类型不稳定型肱骨外髁骨折患儿临床疗效。.
方法: 回顾分析2021年1月—2022年10月3个医疗中心收治的94例不稳定型肱骨外髁骨折患儿临床资料。根据Song分型及是否合并关节脱位分为3组，其中Song 4型42例（A组）、Song 5型38例（B组）、合并关节脱位14例（C组）。3组患儿性别、年龄、侧别、致伤原因、受伤至手术时间等基线资料比较差异无统计学意义（ P>0.05）。均采用超声引导下闭合复位克氏针固定治疗。记录并比较3组患儿手术时间及术后并发症发生情况；采用超声评估闭合复位失败情况。末次随访时行X线片检查，测量患侧Baumann角、髁干角、提携角、外侧骨赘等影像学指标；并测量患侧肘关节伸直、屈曲、旋前、旋后活动度；采用Mayo评分评价肘关节功能。.
结果: A组手术时间显著多于B、C组，差异均有统计学意义（ P<0.05）；B、C组间差异无统计学意义（ P>0.05）。A、B、C组分别有7、2、5例发生闭合复位失败，失败率比较差异无统计学意义（ P>0.05）。患儿均获随访，随访时间6～28个月，平均15.7个月；3组随访时间比较差异无统计学意义（ P>0.05）。术后并发症：A 组2例延迟愈合，4例针道感染，1例滑车坏死，39例发生外侧骨赘；B组1例畸形愈合，5例针道感染，1例再移位，26例发生外侧骨赘；C组2例针道感染，10例发生外侧骨赘。3组各种并发症发生率比较差异均无统计学意义（ P>0.05）。所有患儿均无肘内、外翻畸形发生。末次随访时，除A组髁干角显著大于B、C组（ P<0.05）外，其余影像学指标、肘关节活动度及Mayo评分组间比较差异均无统计学意义（ P>0.05）。.
结论: 超声引导下闭合复位克氏针固定治疗Song 4型肱骨外髁骨折手术时间长、术后并发症多，更易发生外侧骨赘。.
Keywords: Humeral lateralcondylar fracture; children; closed reduction; ultrasound-guided.