微创闭合复位经皮螺钉固定治疗儿童肱骨内 上髁骨折的临床疗效观察

Clinical Efficacy Observation of Minimally Invasive Closed Reduction and Percutaneous Screw Fixation for Humeral Medial Epicondyle Fracture in Children

摘要: 目的：探讨微创闭合复位经皮空心螺钉固定治疗儿童移位型肱骨内上髁骨折的临床疗效及安全性。方法：回顾性分析2022年8月至2024年12月安徽省儿童医院小儿骨科收治的60例移位型肱骨内上髁骨折患儿临床资料。所有患儿均采用微创闭合复位经皮空心螺钉固定治疗。记录手术时间、术中出血量、住院时间及骨折愈合时间；术后随访6个月，采用Mayo肘关节功能评分(MEPS)评价肘关节功能恢复情况，观察术后并发症。结果：60例患儿均顺利完成手术，无中转切开。手术时间(39.47 ± 8.15) min，术中出血量(13.52 ± 4.68) mL，住院时间(5.48 ± 1.52) d。骨折均获得骨性愈合，愈合时间3~7周，平均(4.36 ± 0.92)周。末次随访MEPS评分：优42例，良15例，可3例，优良率95.00%。术后轻微并发症3例，其中肘关节僵硬1例、皮下淤血2例，经对症处理后均恢复正常；无尺神经损伤、切口感染、骨折再移位及骨骺发育异常等严重并发症。结论：微创闭合复位经皮空心螺钉固定治疗儿童移位型肱骨内上髁骨折创伤小、固定可靠、骨折愈合快、肘关节功能恢复良好且并发症少，符合儿童骨科微创治疗理念，具有一定的临床应用价值。

Abstract: Objective: To investigate the clinical efficacy and safety of minimally invasive closed reduction and percutaneous cannulated screw fixation for displaced humeral medial epicondyle fracture in children. Methods: A retrospective analysis was performed on the clinical data of 60 children with displaced humeral medial epicondyle fracture treated in the Department of Pediatric Orthopedics, Anhui Provincial Children’s Hospital from August 2022 to December 2024. All patients underwent minimally invasive closed reduction and percutaneous cannulated screw fixation. Operation time, intraoperative blood loss, length of hospital stay and fracture healing time were recorded. All patients were followed up for 6 months. Elbow function was evaluated by the Mayo Elbow Performance Score (MEPS), and postoperative complications were observed. Results: All 60 operations were successfully completed without conversion to open surgery. The operation time was (39.47 ± 8.15) min, intraoperative blood loss was (13.52 ± 4.68) mL, and hospital stay was (5.48 ± 1.52) days. All fractures achieved bony union within 3~7 weeks, with an average healing time of (4.36 ± 0.92) weeks. At the final follow-up, MEPS showed excellent in 42 cases, good in 15 cases, and fair in 3 cases, with an excellent and good rate of 95.00%. Three minor complications occurred postoperatively, including 1 case of elbow stiffness and 2 cases of subcutaneous ecchymosis, all of which recovered after symptomatic treatment. There were no serious complications such as ulnar nerve injury, incision infection, fracture redisplacement or epiphyseal dysplasia. Conclusion: Minimally invasive closed reduction and percutaneous cannulated screw fixation for displaced humeral medial epicondyle fracture in children has the advantages of less trauma, reliable fixation, rapid fracture healing, satisfactory elbow function recovery and fewer complications. It conforms to the minimally invasive concept of pediatric orthopedics and has certain clinical application value.