Objective: To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children.
Methods: A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation ( P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up.
Results: In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group ( P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant ( P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time ( P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant ( P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups ( P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation.
Conclusion: The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.
目的: 与切开复位克氏针内固定相比，探讨超声辅助下闭合复位经皮克氏针内固定治疗儿童肱骨外髁骨折（humeral lateral condyle fracture，HLCF）的临床疗效。.
方法: 回顾分析2020年5月—2023年4月收治且符合选择标准的53例儿童HLCF临床资料。其中，采用超声辅助下闭合复位经皮克氏针内固定治疗25例（闭合组），切开复位克氏针内固定治疗28例（开放组）。两组患儿性别、年龄、致伤原因、骨折侧别及分型、受伤至手术时间等基线资料比较，差异均无统计学意义（ P>0.05）。比较两组手术时间、术中透视次数、骨折愈合时间、并发症发生情况，以及末次随访时肘关节功能Flynn评分。.
结果: 闭合组均在超声引导下成功复位骨折，两组术中均未发生神经损伤。闭合组手术时间、术中透视次数均低于开放组，差异有统计学意义（ P<0.05）。闭合组术后发生感染1例（钉眼激惹反应）、开放组3例（钉眼激惹反应2例、切口感染1例），两组感染发生率差异无统计学意义（ P>0.05）。两组患儿均获随访，随访时间6～18个月，平均10.2个月。X线片复查示两组骨折均愈合，且愈合时间差异无统计学意义（ P>0.05）；随访期间闭合组、开放组分别有5、12例发生肱骨外侧骨突形成，组间差异无统计学意义（ P>0.05）。末次随访时，闭合组根据Flynn评分标准评价肘关节功能优良率达96.0%（24/25）、开放组为92.9%（26/28），组间差异无统计学意义（ P>0.05）。两组均无骨化性肌炎及肘内、外翻畸形发生。.
结论: 超声辅助下闭合复位经皮克氏针内固定治疗儿童HLCF疗效与切开复位克氏针内固定相当，但前者可减少手术时间和术中透视次数，减少并发症的发生。.
Keywords: Ultrasound; child; closed reduction; humeral lateral condyle fracture; internal fixation.