超声技术在儿童股骨髁上骨折闭合复位内固定手术中的应用价值
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摘要
目的探讨超声技术在儿童股骨髁上骨折闭合复位内固定术中的应用价值。方法回顾性分析2012年1月至2016年6月华中科技大学同济医学院附属武汉儿童医院收治的12例具备手术指征的股骨髁上骨折患儿的临床资料,其中男8例,女4例。年龄8个月至12岁(平均5岁7个月),均采用超声引导下闭合复位克氏针内固定联合石膏外固定治疗,记录手术时间、术后出院时间、并发症及骨折愈合的时间,并于术后6个月、1年及2年分别测量双下肢长度、下肢机械力线及股骨远端骨骺发育情况。末次随访采用Kolment评定标准评价患儿膝关节的优良率。结果 12例中无一例发生神经血管损伤、骨折端移位、膝内外翻畸形、克氏针松动、骨髓炎及骨化性肌炎等并发症。骨折骨性愈合时间为8～12周,平均(9. 7±1. 5)周,无不愈合或延迟愈合的情况。患儿均获1年以上随访,骨折全部愈合,膝关节功能完全恢复,步态正常,双下肢等长,无旋转畸形。术后末次随访膝关节功能优良率为100%。结论超声引导下骨折闭合复位克氏针内固定石膏外固定术治疗效果基本满意。术中通过超声指导儿童的股骨髁上骨折闭合复位及克氏针穿针固定可达到治疗精确定位的目的。
Objective To explore the clinical value of ultrasonic technique in closed reduction plus internal fixation for supracondylar femoral fracture in children. Methods Retrospective analysis was conducted for 12 children with supracondylar femoral fracture from January 2012 to June 2016. There were 8 boys and 4 girls with an average age of 67( 8-144) months. Closed reduction,Kirschner's wire internal fixation and plaster external fixation were performed under ultrasonic guidance. Operative duration,postoperative discharge time,complications and fracture healing time were recorded. Length of lower extremities,mechanical force lines of lower extremities and epiphyseal development of distal femur were measured at 6,12 and 24 months post-operation. And the Kolment's criteria were employed for evaluating knee joint function at the last follow-up. Results During a follow-up period of over 1 year,there were no occurrences of such complications as neurovascular injury,displacement of fracture,Knee varus deformity,Kirschner's wire loosening,osteomyelitis or ossifying myositis. The average time of fracture healing was( 9. 7 ± 1. 5)( 8-12) weeks. All cases healed with a complete recovery of knee joint function.Gait returned to normal. All lower extremities were of an equal length and there was no rotation deformity. Based upon the Kolment's criteria. The excellent and good rate was 100%. Conclusion Ultrasound is safe,economical and reliable for guiding closed reduction and Kirschner's wire fixation for supracondylar femoral fracture in children.
Objective To explore the clinical value of ultrasonic technique in closed reduction plus internal fixation for supracondylar femoral fracture in children. Methods Retrospective analysis was conducted for 12 children with supracondylar femoral fracture from January 2012 to June 2016. There were 8 boys and 4 girls with an average age of 67( 8-144) months. Closed reduction,Kirschner's wire internal fixation and plaster external fixation were performed under ultrasonic guidance. Operative duration,postoperative discharge time,complications and fracture healing time were recorded. Length of lower extremities,mechanical force lines of lower extremities and epiphyseal development of distal femur were measured at 6,12 and 24 months post-operation. And the Kolment's criteria were employed for evaluating knee joint function at the last follow-up. Results During a follow-up period of over 1 year,there were no occurrences of such complications as neurovascular injury,displacement of fracture,Knee varus deformity,Kirschner's wire loosening,osteomyelitis or ossifying myositis. The average time of fracture healing was( 9. 7 ± 1. 5)( 8-12) weeks. All cases healed with a complete recovery of knee joint function.Gait returned to normal. All lower extremities were of an equal length and there was no rotation deformity. Based upon the Kolment's criteria. The excellent and good rate was 100%. Conclusion Ultrasound is safe,economical and reliable for guiding closed reduction and Kirschner's wire fixation for supracondylar femoral fracture in children.
引文
1 Hoffmann CR,Traldi EF,Posser A.Epidemiologicale study of children diaphyseal femoral fractures[J].Rev Bras Ortop,2012,47(2):186-190.DOI:10.1016/S2255-4971(15)30084-7.
2 Javanovic'V,Vukasinovic'Z,Seslija I.Complicated distal femoral epiphyseolysis treated by Ilizarov method:case report[J].Srp Arh Celok Lek,2010,138(5):367-370.DOI:10.2298/SARH1006367J.
3 Arkader A,Warner WC Jr,Horn BD,et al.Predicting the outcome of physeal fractures of the distal femur[J].J Pediatr Orthop,2007,27(6):703-708.DOI:10.1097/BPO.0b013e3180dca0e5.
4杨德育,王月娥,苏在权,等.闭合复位结合Ilizarov环形外固定架治疗儿童股骨髁上骨折[J].中国骨与关节损伤杂志,2017,1(6):63-67.DOI:10.3969/j.issn.2095-252X.2017.01.013.Yang DY,Wang YE,Su ZQ,et al.Closed reduction with Ilizarov external fixator for supracondylarfracturesof the femur in pediatric patients[J].Chin J Bone and Joint,2017,1(6):63-67.DOI:10.3969/j.issn.2095-252X.2017.01.013.
5宋宝健,王强,冯伟,等.外固定架治疗儿童股骨转子下骨折[J].临床小儿外科杂志,2016,15(1):63-65.DOI:10.3969/j.issn.1671-6353.2016.00.01.Song BJ,Wang Q,Feng W,et al.External fixator for treatment of femoral subtrochanteric fracture in children[J].JClin Ped Sur,2016,15(1):63-65.DOI:10.3969/j.issn.1671-6353.2016.00.01.
6 Gill S,Mittal A,Raj M,et al.Extra articular supracondylar femur fractures managed with locked distal femoral plate or supracondylar nailing:a comparative outcome study[J].JClin Diagn Res,2017,11(5):RC19-RC23.DOI:10.7860/JCDR/2017/25062.9936.
7 Bai Z,Gao S,Hu Z,et al.Comparison of clinical efficacy of lateral and lateral and medial double-plating fixation of distal femoral fractures[J].Sci Rep,2018,8(1):4863.DOI:10.1038/s41598-018-23268-8.
8左玉明,闫荣亮,左大鹏,等.锁加压钢板与克氏针治疗大龄儿童股骨远端粉碎骨折的疗效比较[J].中国煤炭工业医学杂志,2016,8(19):1154-1157.DOI:10.11723/mtgyyx 1007-9564 201608019.Zuo YM,Yan RL,Zuo DP,et al.Comparison between locking compression plate(LCP)and kirschner for the treatment of distal femoral fracture of older children[J].Chinese Journal of Coal Industry Medicine,2016,8(19):1154-1157.DOI:10.11723/mtgyyx 1007-9564 201608019.
9 Weng CJ,Wu CC,Feng KF,et al.Comparison of supraintercondylar and supracondylar femur fractures treated with condylar buttress plates[J].BMC Musculoskelet Disord,2016,17(1):413.DOI:10.1186/s12891-016-1278-2.
10李海冰,叶文松,徐璐杰,等.儿童股骨远端骺板骨折的治疗及并发症[J].浙江医学,2016,38(19):1590-1593.Li HB,Ye WS,Xu LJ,et al.Management of distal femoral epiphyseal plate fractures in children[J].Zhejiang Medical Journal,2016,38(19):1590-1593.
11 Shital N,Parikh,Senthil T,et al.Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures[J].Clin Orthop Relat Res,2014,472(9):2735-2744.DOI:10.1007/s11999-013-3240-z.
12解平锋,牛和明,叶元.经皮交叉克氏针固定治疗移位型儿童股骨髁上骨折的疗效观察[J].现代诊断与治疗,2014,25(21):4844-4846.Xie PF,Niu HM,Ye Y,et al.Clinical observation of cross percutaneous pinning in the treatment of fracture of femoral condyle in displaced children[J].2014,25(21):4844-4846.
13 Jacobsen S,Hansson G,Nathorst-Westfelt J.Traumatic separation of the distal epiphysis of the humerus sustained at birth[J].J Bone Joint Surg Br,2009,91(6):797-802.DOI:10.1302/0301-620X.91B6.22140.
14杨晓东,唐学阳,蒋欣,等.超声技术在儿童前臂骨折闭合复位弹性髓内针内固定术中的应用[J].临床小儿外科杂志,2015,14(4):287-289.DOI:10.3969/j.issn.1671-6353.2015.04.01.Yang XD,Tang XY,Jiang X,et al.Ultrasound technology in children's forearm fracture closed reduction and flexible intramedullary nail fixation[J].J Clin Ped Sur,2015,14(4):287-289.DOI:10.3969/j.issn.1671-6353.2015.04.01.
15沈先涛,陈小亮,李雄涛,等.婴幼儿肱骨远端骨折超声诊断及辅助治疗的临床意义[J].中华小儿外科杂志,2015,36(2):141-144.DOI:10.3760/cma.j.issn.0253-3006.2015.02.015.Shen XT,Chen XL,Li XT,et al.Ultrasonic diagnosis of distal humeral fracture in infants and toddlers and its clinical significance of ancillary treatment[J].Chin J Ped Sur,2015,14(4):287-289.DOI:10.3969/j.issn.1671-6353.2015.04.01.
16沈先涛,陈小亮,李雄涛,等.B型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折[J].中华小儿外科杂志,2015,36(5):363-367.DOI:10.3760/cma.j.issn.0253-3006.2015.05.011.Shen XT,Chen XL,Li XT,et al.Ultrasound guided percutaneous Kirschner's wire leverage and reduction for radial neck fracture in children[J].Chin J Pediatr Surg,2015,36(5):363-367.DOI:10.3760/cma.j.issn.0253-3006.2015.05.011.
17陈小亮,唐玲华,周治国,等.彩色多普勒超声在儿童桡骨小头半脱位的诊断与治疗中的应用[J].临床外科杂志,2017,25(9):691-693.DOI:10.3969/j.issn.1005-6483.2017.09.019.Chen XL,Tang LH,Zhou ZG,et al.The application of Color Doppler ultrasound in the diagnosis and treatment of radial head subluxation in children[J].J Clin Surg,2017,25(9):691-693.DOI:10.3969/j.issn.1005-6483.2017.09.019.
2 Javanovic'V,Vukasinovic'Z,Seslija I.Complicated distal femoral epiphyseolysis treated by Ilizarov method:case report[J].Srp Arh Celok Lek,2010,138(5):367-370.DOI:10.2298/SARH1006367J.
3 Arkader A,Warner WC Jr,Horn BD,et al.Predicting the outcome of physeal fractures of the distal femur[J].J Pediatr Orthop,2007,27(6):703-708.DOI:10.1097/BPO.0b013e3180dca0e5.
4杨德育,王月娥,苏在权,等.闭合复位结合Ilizarov环形外固定架治疗儿童股骨髁上骨折[J].中国骨与关节损伤杂志,2017,1(6):63-67.DOI:10.3969/j.issn.2095-252X.2017.01.013.Yang DY,Wang YE,Su ZQ,et al.Closed reduction with Ilizarov external fixator for supracondylarfracturesof the femur in pediatric patients[J].Chin J Bone and Joint,2017,1(6):63-67.DOI:10.3969/j.issn.2095-252X.2017.01.013.
5宋宝健,王强,冯伟,等.外固定架治疗儿童股骨转子下骨折[J].临床小儿外科杂志,2016,15(1):63-65.DOI:10.3969/j.issn.1671-6353.2016.00.01.Song BJ,Wang Q,Feng W,et al.External fixator for treatment of femoral subtrochanteric fracture in children[J].JClin Ped Sur,2016,15(1):63-65.DOI:10.3969/j.issn.1671-6353.2016.00.01.
6 Gill S,Mittal A,Raj M,et al.Extra articular supracondylar femur fractures managed with locked distal femoral plate or supracondylar nailing:a comparative outcome study[J].JClin Diagn Res,2017,11(5):RC19-RC23.DOI:10.7860/JCDR/2017/25062.9936.
7 Bai Z,Gao S,Hu Z,et al.Comparison of clinical efficacy of lateral and lateral and medial double-plating fixation of distal femoral fractures[J].Sci Rep,2018,8(1):4863.DOI:10.1038/s41598-018-23268-8.
8左玉明,闫荣亮,左大鹏,等.锁加压钢板与克氏针治疗大龄儿童股骨远端粉碎骨折的疗效比较[J].中国煤炭工业医学杂志,2016,8(19):1154-1157.DOI:10.11723/mtgyyx 1007-9564 201608019.Zuo YM,Yan RL,Zuo DP,et al.Comparison between locking compression plate(LCP)and kirschner for the treatment of distal femoral fracture of older children[J].Chinese Journal of Coal Industry Medicine,2016,8(19):1154-1157.DOI:10.11723/mtgyyx 1007-9564 201608019.
9 Weng CJ,Wu CC,Feng KF,et al.Comparison of supraintercondylar and supracondylar femur fractures treated with condylar buttress plates[J].BMC Musculoskelet Disord,2016,17(1):413.DOI:10.1186/s12891-016-1278-2.
10李海冰,叶文松,徐璐杰,等.儿童股骨远端骺板骨折的治疗及并发症[J].浙江医学,2016,38(19):1590-1593.Li HB,Ye WS,Xu LJ,et al.Management of distal femoral epiphyseal plate fractures in children[J].Zhejiang Medical Journal,2016,38(19):1590-1593.
11 Shital N,Parikh,Senthil T,et al.Elastic nailing for pediatric subtrochanteric and supracondylar femur fractures[J].Clin Orthop Relat Res,2014,472(9):2735-2744.DOI:10.1007/s11999-013-3240-z.
12解平锋,牛和明,叶元.经皮交叉克氏针固定治疗移位型儿童股骨髁上骨折的疗效观察[J].现代诊断与治疗,2014,25(21):4844-4846.Xie PF,Niu HM,Ye Y,et al.Clinical observation of cross percutaneous pinning in the treatment of fracture of femoral condyle in displaced children[J].2014,25(21):4844-4846.
13 Jacobsen S,Hansson G,Nathorst-Westfelt J.Traumatic separation of the distal epiphysis of the humerus sustained at birth[J].J Bone Joint Surg Br,2009,91(6):797-802.DOI:10.1302/0301-620X.91B6.22140.
14杨晓东,唐学阳,蒋欣,等.超声技术在儿童前臂骨折闭合复位弹性髓内针内固定术中的应用[J].临床小儿外科杂志,2015,14(4):287-289.DOI:10.3969/j.issn.1671-6353.2015.04.01.Yang XD,Tang XY,Jiang X,et al.Ultrasound technology in children's forearm fracture closed reduction and flexible intramedullary nail fixation[J].J Clin Ped Sur,2015,14(4):287-289.DOI:10.3969/j.issn.1671-6353.2015.04.01.
15沈先涛,陈小亮,李雄涛,等.婴幼儿肱骨远端骨折超声诊断及辅助治疗的临床意义[J].中华小儿外科杂志,2015,36(2):141-144.DOI:10.3760/cma.j.issn.0253-3006.2015.02.015.Shen XT,Chen XL,Li XT,et al.Ultrasonic diagnosis of distal humeral fracture in infants and toddlers and its clinical significance of ancillary treatment[J].Chin J Ped Sur,2015,14(4):287-289.DOI:10.3969/j.issn.1671-6353.2015.04.01.
16沈先涛,陈小亮,李雄涛,等.B型超声引导经皮克氏针撬拨治疗儿童桡骨颈骨折[J].中华小儿外科杂志,2015,36(5):363-367.DOI:10.3760/cma.j.issn.0253-3006.2015.05.011.Shen XT,Chen XL,Li XT,et al.Ultrasound guided percutaneous Kirschner's wire leverage and reduction for radial neck fracture in children[J].Chin J Pediatr Surg,2015,36(5):363-367.DOI:10.3760/cma.j.issn.0253-3006.2015.05.011.
17陈小亮,唐玲华,周治国,等.彩色多普勒超声在儿童桡骨小头半脱位的诊断与治疗中的应用[J].临床外科杂志,2017,25(9):691-693.DOI:10.3969/j.issn.1005-6483.2017.09.019.Chen XL,Tang LH,Zhou ZG,et al.The application of Color Doppler ultrasound in the diagnosis and treatment of radial head subluxation in children[J].J Clin Surg,2017,25(9):691-693.DOI:10.3969/j.issn.1005-6483.2017.09.019.