الملخص
OBJECTIVE@#To compare the effectiveness of ultrasound- and arthrography-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ lateral condylar humerus fracture (LCHF) in children.@*METHODS@#A clinical data of 101 children with Jakob type Ⅱ LCHF, who met the selection criteria and were admitted between April 2021 and April 2022, was retrospectively analyzed. Of them, 47 cases were treated with ultrasound-assisted Kirschner wire fixation (group A), and 54 cases with arthrography-assisted surgery (group B). There was no significant difference in gender, age, cause of injury, fracture side, and disease duration between groups (P>0.05). Intraoperative fluoroscopy times, operation time, and hospital stay, Flynn elbow joint function score, and postoperative complications were recorded and compared between groups. X-ray examination was performed to observe the healing of fracture, and measure the carrying angle and the shaft-condylar angle (SCA).@*RESULTS@#The success rate of closed reduction was significantly higher in group A than in group B (P<0.05), and the intraoperative fluoroscopy times was significantly less in group A than in group B (P<0.05). There was no significant difference in operation time and hospital stay between groups (P>0.05). All children in both groups were followed up 12-18 months, with an average of 13.6 months. X-ray reexamination showed that the fractures of both groups healed, and the difference in healing time was not significant (P>0.05). At last follow-up, there was no significant difference in carrying angle and SCA between unaffected side and affected side in both groups and between groups A and B in affected side (P>0.05). There was no significant difference in Flynn elbow joint function score between groups (P>0.05). There were 18 cases of lateral spurs formation in group A, 1 case of pinning infection and 26 cases of lateral spurs formation in group B, and there was no significant difference in the incidence of the above complications (P>0.05).@*CONCLUSION@#Compared with the arthrography, the ultrasound-assisted Kirschner wire fixation in the treatment of Jakob type Ⅱ LCHF in children can avoid the open reduction and decrease the number of intraoperative fluoroscopy, and obtain the good effectiveness.
الموضوعات
Child , Humans , Male , Female , Arthrography , Bone Wires , Humeral Fractures/surgery , Humerus , Retrospective Studiesالملخص
OBJECTIVE@#To investigate the short-term effectiveness of ultrasound-guided closed reduction by Kirschner wire provocation technique in the treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents.@*METHODS@#Between May 2019 and May 2022, 41 patients with Salter Harris types Ⅰ and Ⅱ distal tibial epiphyseal fractures were admitted, all of whom had periosteal entrapment on preoperative MRI, and 38 cases (92.7%) were confirmed to have periosteal entrapment by intraoperative ultrasound. There were 24 males and 14 females, the age ranged from 6.8 to 15.7 years, with an average of 10.7 years; and there were 20 cases of Salter Harris type Ⅰ and 18 cases of type Ⅱ. The time from injury to operation was 22-76 hours, with an average of 28.4 hours. The preoperative imaging examination showed excellent alignment in 4 cases, good in 20 cases, and poor in 14 cases. The ultrasound guided Kirschner wire provocation technique for closed reduction and percutaneous Kirschner wire internal fixation were performed. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Anteroposterior and lateral X-ray films of the affected ankle joint were taken before operation, at 3 months after operation, and at last follow-up to observe the healing of the fracture, and anteroposterior X-ray films of the whole length of both lower limbs were taken to evaluate the alignment of the force lines of the affected limbs. The range of motion (ROM), visual analogue scale (VAS) score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used to evaluate ankle function. The mechanical lateral distal tibia angle (mLDTA) and the anatomic anterior distal tibia angle (aADTA) were measured.@*RESULTS@#The operation time ranged from 17 to 52 minutes, with an average of 22.6 minutes, and the intraoperative fluoroscopy frequency ranged from 3 to 11 times, with an average of 4.2 times. X-ray examination during operation and at 2 days after operation showed that anatomical reduction was achieved. All patients were followed up 10-24 months, with an average of 16.4 months. All fractures healed in 6.1-7.2 weeks, with an average of 6.3 weeks; no fracture displacement occurred, and the patients recovered to their pre-injury level of motion at 6 months after operation. Needle tail irritation occurred in 2 cases at 4 weeks after operation, and they recovered after symptomatic treatment. During the follow-up, there was no serious complication such as incision deep infection, bone nonunion, delayed union, and malunion. At last follow-up, the patients' alignment were all excellent, and the difference was significant when compared with preoperative one ( Z=-7.471, P<0.001). The VAS score, AOFAS ankle-hindfoot score, dorsiflexion-plantar flexion ROM, varus-valgus ROM, mLDTA, and aADTA significantly improved at 3 months after operation and last follow-up when compared with preoperative ones ( P<0.05).@*CONCLUSION@#Ultrasound-guided closed reduction by Kirschner wire provocation technique for treating Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents is minimally invasive and safe.
الموضوعات
Male , Female , Child , Humans , Adolescent , Tibia , Bone Wires , Treatment Outcome , Fractures, Bone/surgery , Fracture Fixation, Internal/methods , Ultrasonography, Interventional , Retrospective Studies , Tibial Fractures/surgeryالملخص
Objective:To investigate the clinical efficacy of Kirschner wire reconstruction of periosteal hinge combined with "rolling pin" technique assisting closed reduction and percutaneous Kirschner wire fixation versus closed reduction and percutaneous Kirschner wire fixation in the treatment of flexion-radial deviated supracondylar fracture of the humerus in children.Methods:A retrospective cohort study was used to analyze the clinical data of 85 patients with flexion-radial deviated supracondylar fracture of the humerus treated in Anhui Provincial Children ′s Hospital from January 2017 to December 2021, including 53 males and 32 females; aged 4-14 years [(7.4±2.7)years]. There were 49 patients treated by Kirschner wire reconstruction of periosteal hinge combined with "rolling pin" technique assisting closed reduction and percutaneous Kirschner wire fixation (study group) and 36 patients by closed reduction and percutaneous Kirschner wire fixation (control group). The operation time, number of intraoperative fluoroscopy, rate of incision after failure of closed reduction (hereinafter referred to as rate of incision), fracture healing time, and elbow joint function by Flynn score at the last follow-up were compared between the two groups. Complications were observed at 2 months after operation, such as infection and irritation of the Kirschner pin tail. Results:All patients were followed up for 2-12 months [(6.2±2.2)months]. The operation time and number of intraoperative fluoroscopy was (62.4±21.4)minutes and (34.8±7.1)times in control group, significantly longer or more than (31.2±14.1)minutes and (22.5±5.1) times in study group ( P<0.05 or 0.01). The incision rate was 17% in control group, but was 0 in study group ( P<0.01). The fracture healing time had no significant difference between control group and study group [(4.5±0.8)weeks vs. (4.6±0.6)weeks] ( P>0.05). According to Flynn score at the last follow-up, the excellent and good rate of elbow function was 89% in control group (excellent in 26 patients, good in 6, fair in 4, poor in none), not significantly different from 94% in study group (excellent in 41 patients, good in 5, fair in 3, poor in none) ( P>0.05). There was no infection or irritation of the Kirschner pin tail in the two groups at 2 months after operation. Conclusion:Kirschner wire reconstruction of periosteal hinge combined with "rolling pin" technique assisting closed reduction and percutaneous Kirschner wire fixation has similar effect to closed reduction and percutaneous Kirschner wire fixation in the treatment of flexion-radial deviated supracondylar fracture of the humerus, but the former has relatively shorter operation time, less intraoperative fluoroscopy and lower incision rate.
الملخص
Methods:Two thousand standard sections images werre collected from 2 000 clinical retrospective pediatric hip ultrasound videos from January 2019 to January 2021. All standard sections were annotated by the annotation team through the self-designed software based on Python 3.6 environment for image cross-media data annotation and manual review standardization process with unified standards. Among them, 1 753 were randomly selected for training the deep learning system, and the remaining 247 were used for testing the system. Further, 200 standard sections were randomly selected from the test set, and 8 clinicians independently completed the film reading annotation. The 8 independent results were then compared with the AI results.Results:The testing set consists of 247 patients. Compared with the clinician's measurements, the area under the receiver operating characteristic curve (AUC) of diagnosing hip joint maturity was 0.865, the sensitivity was 76.19%, and the specificity was 96.9%. The AUC of AI system interpretation under Graf detailed typing was 0.575, the sensitivity was 25.90%, the specificity was 89.10%. The 95% LoA of α-angle determined by Bland-Altman method, of -4.7051° to 6.5948° ( Bias -0.94, P<0.001), compared with clinicians' measurements. The 95% LoA of β-angle, of -7.7191 to 6.8777 ( Bias -0.42, P=0.077). Compared with those from 8 clinicians, the results of AI system interpretation were more stable, and the β-angle effect was more prominent. Conclusion:The AI system can quickly and accurately measure the Graf correlation index of standard DDH ultrasonic standard diagnosis plane.