Biocompatibility of Kirschner wire versus absorbable rod fixation for repairing supracondylar fracture of humerus in children

doi:10.3969/j.issn.2095-4344.2015.26.023

Abstract

Abstract:

BACKGROUND: Humeral supracondylar fracture is a common fracture occurred in children. The selection of internal fixation for humeral supracondylar fracture remains controversial.
OBJECTIVE: To compare the biocompatibility between internal fixation with Kirschner wire and bioabsorbable implants for humeral supracondylar fractures.
METHODS: From January 2007 to January 2013, 246 cases of humeral supracondylar fractures, from Affiliated Hospital of Luzhou Medical College, were treated by internal fixation with Kirschner wire. Meanwhile, the studies on internal fixation for treating supracondylar fracture of humerus in children were searched. Efficacy was evaluated by preoperative and postoperative elbow range of motion and the incidence of cubitus varus, and the results were statistically analyzed, and compared with other therapeutic methods.
RESULTS AND CONCLUSION: All cases were followed up for 6-36 months, averagely 18 months. According to Mayo elbow performance score, function of the elbow joint was excellent in 194 cases, and good in 48 cases, with good and excellent rate being 98.4%. Four cases suffered < 5° cubitus varus, with incidence rate of 1.63%. The internal fixation with Kirschner wire provided functional recovery of elbow joint, but the second stage operation was needed to pick out the wires. And it might be perplexed by Kirschner wire loosening or needle withdrawal, resulting in instable fixation. Bioabsorbable implants were effective in the treatment of supracondylar fracture of humerus. Bioabsorbable sticks would break down over time, without harming to human body or influencing
imaging examination. Elbow function development of the epiphysis would not be affected. However, due to lack of large-sample observation, long-term effects of bioabsorbable implants for treating supracondylar fracture of humerus in children deserve further studies.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Humerus, Fractures, Bone, Fracture Fixation, Recovery of Function

CLC Number:

R318

Wang Yuan-hui, Wan Yong-xian, Ye Li-zi, Luo Lei-ming, Tan Mei-yun. Biocompatibility of Kirschner wire versus absorbable rod fixation for repairing supracondylar fracture of humerus in children[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(26): 4218-4222.

Figures/Tables 2

2.1 参与者数量分析 246例患者接受6-24个月随访，平均随访12个月，所有患者进入结果分析。 2.2　修复结果泸州医学院附属医院2007年1月至2013年1月收治的246修复肱骨髁上骨折患者中，4例发生 < 5°肘内翻，肘内翻发生率为1.63%。修复后Mayo肘关节功能评分标准，优194例，良48例，优良率 98.4%。 2.3 克氏针内固定修复儿童肱骨髁上骨折的相关研究结果陈情忠等[19]对2010年7月至2011年12月对34例采用肘后人路切开复位克氏针内固定修复复杂肱骨髁上骨折患儿进行了16-32个月的随访，平均(21.7±4.4)个月。按照肱三头肌不同的处理方法，将病例分为肱三头肌正中切开入路组(n=19)，肱三头肌旁入路组(n=15)。记录随访结果，并对最后一次随访结果进行统计学分析。两组病例中肘关节活动度及前臂旋前、旋后活动范围均在正常范围，两组间差异无统计学意义。患侧伸肘肌力与健侧的百分比，两组间差异无统计学意义。Mayo肘关节功能评分均为100分，两组间差异无统计学意义。测量Baumann角、肱骨干髁角，两组的均值均在正常范围内，两组间的差异无统计学意义。肱三头肌旁及肱三头肌正中切开两种入路在肱骨髁上骨折修复中可取得相同的修复效果。何晖等[20]将51例3-14岁的Gaxtland III型肱骨髁上骨折患儿，采用应用随机数字表分组的方法，随机分为挠侧入路克氏针加捆绑带内固定修复和传统双侧入路切开复位交叉克氏针内固定修复组，修复后1周内神经症状发生率、修复后2周后肘关节活动范围、修复后3个月后肘内翻畸形发生率、骨化性肌炎发生率、修复后第2天及拆除内固定后进行肘部正位X射线片B角(即Baumann角)度数、总体疗效评价等指标观察和比较两组的临床疗效。两组均达临床愈合，肘内翻畸形、神经症状发生率、膏化性肌炎发生率及临床愈合时间比较差异无显著性意义(P > 0.05)；而两组肘部正位X射线片B角度数、肘关节活动范围、总体疗效评价，差异有显著性意义(P < 0.05)。研究表明，克氏针加捆绑带内固定修复Gartland III型儿童肱骨髁上膏折具有创伤小，内固定可靠，有效改善肘关节活动范围，降低肘内翻畸形发生率，提高临床疗效的优势。 2.4 克氏针和拉力螺钉修复儿童肱骨内上髁骨折的相关研究结果的比较研究宫伟等[21]对2002年6月至2009年12月行手术修复的78例儿童肱骨内上髁骨折进行分析，拉力螺钉组修复结果显著高于克氏针组。两组均未出现骨折再移位、纤维愈合、畸形愈合、不愈合及肘关节不稳以及迟发性尺神经麻痹等不良反应出现。作者认为，切开复位并拉力螺钉内固定结合早期功能锻炼修复儿童肱骨内上髁骨折，能保证使患儿肘关节功能在较短时间内得到最大程度的恢复，实现满意的复位和坚强的固定，为肘关节的早期功能锻炼创造条件，相关研究结果见表1。 2.5 可吸收钉、棒内固定修复儿童肱骨内上髁骨折相关研究结果的比较为探讨可吸收钉、棒内固定修复儿童肱骨内上髁骨折的疗效及优缺点。赵仁欢等[11]对2009至2011年采用切开复位可吸收钉、棒内固定修复的23例儿童肱骨内上髁骨折进行分析，研究显示，可吸收材料在体内随着时间推移自行分解对人体无害，不影响影像学检查，无需二期手术取出内固定材料。修复后可行早期功能锻炼，骨折愈合效果肯定，不影响关节功能及骨骺发育。研究结果见表2。蓝吉斌等[22]应用可吸收棒固定修复儿童肱骨内上髁骨折的研究表明，自体增强-聚丙交酯可吸收棒具有稳定性好、修复后功能恢复理想、并发症少、可避免二次手术等优点，是修复肱骨内上髁骨折较理想的选择。可吸收棒置人体内后，随着时间的推移逐渐开始降解，强度逐渐下降，一般在3-12个月失去其机械强度，2-4年完全被吸收，而骨折愈合的时间一般在3-6周内完成，儿童一般在3周之内即可愈合，可吸收棒固定值得临床推广，研究结果见表3。"

References

[1] Shannon FJ, Mohan P, Chacko J, et al. "Dorgan's" percutaneous lateral cross-wiring of supracondylar fractures of the humerus in children. J Pediatr Orthop. 2004;24(4): 376-379.
[2] Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109(2): 145-154.
[3] 潘少川.实用小儿骨科学[M].2版.北京:人民卫生出版社, 2005: 443.
[4] 胡飞,尚希福,赵其纯,等.儿童肱骨髁上骨折两种外侧入路切开复位的临床比较[J].中国矫形外科杂志, 2011,19(20):1677-1681.
[5] 卢世壁,王继芳,王岩,等主译.坎贝尔骨科手术学[M].10版.济南:山东科学技术出版社, 2005:1356-1357.
[6] 王岩.坎贝尔骨科手术学(中文版)[M].12版.人民军医出版社, 2013:1296-1307.
[7] Haflah NH, Ibrahim S, Sapuan J, et al. An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy. J Pediatr Orthop B. 2010;19(5):459-461.
[8] Louahem DM, Bourelle S, Buscayret F,et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg. 2010:130(5):649-655.
[9] Farsetti P, Potenza V, Caterini R, et al. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am. 2001;83-A(9):1299-1305.
[10] Sawyer JR, Hicks JM, Canale ST, et al. The hammerlock position revisited: prone positioning for open reduction of medial epicondylar fractures in children. Curt Orthop Pract. 2009;20(5):572-574.
[11] 赵仁欢,覃佳强,南国新.可吸收钉、棒内固定治疗儿童肱骨内上髁骨折[J].重庆医科大学学报, 2013, 38(11):1268-1271.
[12] 王亦璁.骨与关节损伤[M].北京:人民卫生出版社,2005,595-598.
[13] 李曙光.肱骨内上髁骨折治疗体会[J].中国医学创新, 2010, 7(16):64-65.
[14] 丁晓飞,廖世杰,赵劲民,等.闭合复位经皮克氏针固定治疗儿童伸直型肱骨髁上骨折－内外侧穿针与单纯外侧穿针的疗效比[J].中国矫形外科杂志, 2012, 20(12):1067-1071.
[15] 张忠荣,杨星华,王子明,等.骨片钉治疗儿童肱骨髁上骨折[J].中国骨与关节损伤杂志, 2009, 24(11):1027-1028.
[16] 王浩然,仲肇平,陈秋. GartlandⅢ型儿童肱骨髁上骨折的治疗方式探讨[J].临床骨科杂志, 2014, 17(3):281-284.
[17] 顾荣胜,王付贵,范广峰.2种方法治疗GartlandⅢ型儿童髁上骨折的早期疗效观察[J]. 齐齐哈尔医学院学报, 2015, 36(13): 1941-1943.
[18] 蔡豪祺,王志刚,蔡海清,等.钛制弹性髓内钉治疗儿童肱骨高位髁上骨折及交界性骨折. 中华小儿外科杂志,2011, 32(11): 845-849.
[19] 陈情忠,龚炎培,顾剑辉.两种手术人路治疗复杂小儿肱骨髁上骨折疗效的比较[J].中华手外科杂志.2014;30(2):124-126.
[20] 何晖,张亚忠,黎旭军,等.桡侧入路克氏针加捆绑带内固定治疗Gartlandni型儿童肱骨髁上骨折的临床研究[J]. 广西中医药大学学报.2014;17(1):33-36.
[21] 宫伟,李炳钻,王建嗣,等. 克氏针和拉力螺钉治疗儿童肱骨内上髁骨折疗效比较[J].中国中医骨伤科杂志. 2012;20(10): 38-42.
[22] 蓝吉斌,邓洪辉,宿玉玺,等. 可吸收棒固定治疗儿童肱骨内上髁骨折. 中华创伤杂志,2014:30(8):786-789.
[23] 谢廷华,蔡国雄,王爱民,等.两种方法治疗小儿肱骨髁上骨折的疗效比较[J].新中医,2013,45(5):145-147.
[24] Dimeglio A. Growth in pediatric orthopaedics. In: Mrrissy RT, Weinsten SL. Lovell and Winters's pediatric Orthopaedics[M]. 6th Edit. philadelphia: Lippincott Williams and Wilkins, 2006: 35-65.
[25] 杨建平.儿童肱骨髁上骨折的现代处理[J].中华创伤骨科杂志，2009,11(4):659-661.
[26] Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children: sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am. 1974, 56(2):263-272.
[27] Skaggs DL, Cluck MW, Mostofi A,et al. Lateral-entry pin fixation in the management of Supracondylar fractures in children.J Bone Joint Surg Am. 2004;86:702-707.
[28] 向启利,徐永清,杨怀芬,等.儿童肱骨髁上骨折不同手术入路的比例分析[J]. 临床骨科杂志, 2012,15(4):407-408.
[29] 袁华军，黎忠文，陈武.儿童肱骨髁上骨折230例手术治疗评价[J].中国骨伤，2009,24（5）：456-457.
[30] 高守国.内外侧切口双交叉克氏针固定治疗肱骨髁上骨折[J].基层医学论坛, 2008,12(2)中旬刊:138-139.
[31] Kocher MS, Kasser JR, Waters PM, et al.Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial.J Bone Joint Surg Am. 2007;89(4):706-712.
[32] Lee KM, Chung CY, Gwon DK, et al.Medial and lateral crossed pinning versus lateral pinning for supracondylar fractures of the humerus in children: decision analysis. J Pediatr Orthop. 2012;32(2):131-138.
[33] 李清洋,庞德仁,国小梅,等.肘内侧入路治疗儿童肱骨髁上骨折[J].中国骨与关节外科，2009,2(6):473-474.
[34] 张德洲,易雪冰,钟鉴,等.儿童肘关节损伤致肘内翻畸形机制探讨[J].中国骨伤, 2010,23(1):39-41.