目的 总结超声引导闭合复位和弹性髓内钉固定微创治疗儿童肱骨近端骨折的疗效.方法 在 2018 年 1 月至2021 年 12 月期间,使用超声引导闭合复位和弹性髓内钉固定儿童肱骨近端骨折 14 例,Neer-HorwitzⅢ型 9 例,Ⅳ型 5 例;平均年龄 9.5 岁(7～14 岁).术中应用超声引导闭合复位、弹性髓内钉将骨折固定,必要时经皮克氏针翘拨辅助复位,超声动态检测骨折复位质量.结果 超声引导闭合复位成功 13 例,1 例术中转为有限切开复位,闭合成功率 92.86%.本组病例术后平均随访时间 13.7 个月;骨折均获一期愈合,愈合时间:4～10 w(平均 7.1 w).术后Neer肩关节功能评分:83～100(平均 94.71).弹性髓内钉钉尾软组织刺激征 2 例,无其他并发症.结论 超声引导闭合复位和弹性髓内钉固定可能是治疗儿童肱骨近端骨折较好的方法.

Background A radius neck fracture in children is a common fracture that not only affects the growth and development of children but also has a certain impact on the function of children's elbow joints. Objective To probe into the application value of ultrasonography- (US-) guided combination with elbow arthrography in the minimally invasive treatment of radial neck fractures in young children, summarize its clinical effect and provide a minimally invasive, safe, effective, and reliable method for treating radial neck fractures in young children. Methods Seventy-three patients with type III or IV radial neck fractures were treated from June 2013 to December 2020 and were divided into the Métaizeau group (n = 31, treatment group) and Kirschner wire (k-wire) k-wire group (n = 42, control group). The Métaizeau group was given US-guided combination with elbow arthrography-assisted modified Métaizeau technique, the k-wire group received open reduction and internal fixation with k-wire and compared the surgical effect of the two groups. Results In comparison with the k-wire group, time of operation, intraoperative bleeding volume, and hospital stay were signally junior to those in the Métaizeau group (P < 0.05). After surgery, in comparison with the k-wire group, the number of degrees to contralateral flexion or forearm rotation was visually lower in the Métaizeau group (P < 0.05), and postoperative complication incidence in the Métaizeau group was visually lower than that in k-wire group (P < 0.05). Conclusion In the minimally invasive treatment of radial neck fractures, US-guided combination with elbow arthrography in young children has better efficacy and high safety. It can be widely promoted and applied clinically.

INTRODUCTION:Tigecycline is one of the last resorts for carbapenem-resistant K. pneumoniae (CRKP) infections. Indeed, tigecycline-non-susceptible K. pneumoniae (TNSKP) strains are increasingly treated with the use of tigecycline. In this study, we attempted to better understand their epidemiological trends and characteristics. K. pneumoniae were collected from 2017 to 2020 at the First Affiliated Hospital of Nanchang University.METHODS:Thirty-four TNSKP strains were selected during the study period, all of which were analyzed using antimicrobial susceptibility testing, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). PCR and DNA sequencing were performed for the detection of β-lactamase genes and carbapenemase genes, and the mutation analysis of tet(A), tet(X), tet(L), tet(M), rpsJ, ramR, and oqxR, which are related to tigecycline resistance. Virulence gene and capsular genotype testing were conducted to identify whether the TNSKP strains were hypervirulent Klebsiella pneumoniae.RESULTS:An epidemiology analysis showed that Klebsiella pneumoniae carbapenemase-2 (KPC-2) was the predominant carbapenemase in tigecycline non-susceptible carbapenem-resistant K. pneumoniae (TNSCRKP) (96.7%), and the dominant clone type was ST11-K14K64 (82.4%). Among them, 55.9% (19/34) of strains were from each department of ICU, particularly EICU and neurosurgery ICU. In order to further understand the molecular mechanisms of the TNSKP, a polymerase chain reaction of the resistant determinants was carried out. The results detected many tigecycline-resistant genes, such as tet(A) (97.1%), tet(X) (17.6%), rpsJ (97.1%), and ramR (8.8%).CONCLUSION:As the results of this study reveal, we should take effective measures to control the increase in TNSKP.

目的 探讨超声引导改良三维手法闭合复位经皮克氏针固定儿童屈曲型肱骨髁上骨折的临床疗效.方法 2018年6月至2020年12月,采用本方法治疗儿童屈曲型肱骨髁上骨折患儿17例,按Gartland分型:Ⅱb10例,Ⅲ型7例.所有患者均采用超声引导手法闭合复位经皮克氏针固定的方法治疗.术后石膏外固定4～6周,4～8周后拔出克氏针.结果 18例成功获得闭合复位,无中转切开复位者.1例失访,其余17例获得随访,平均随访时间9.71±3.9月.骨折均获一期愈合,平均愈合时间5.24±1.25周.JOA肘关节功能评分标准评价:优良率为94.12％.结论 超声检查无辐射、无创,术中可以多个平面观察并引导骨折复位及内固定植入,术中更好地维持骨折复位,提高闭合复位几率,减少神经损伤,降低医患X线辐射,是治疗屈曲型儿童肱骨髁上骨折较为理想的手术方法.

Objective To compare the clinical effectiveness of a novel approach, percutaneous leverage reduction using two Kirschner-wires (k-wires) combined with the Métaizeau technique, versus open reduction plus internal fixation with k-wire for the treatment of Judet IV radial neck fractures in children. Methods Thirty-four patients with Judet IV radial neck fractures were treated either with percutaneous leverage reduction using two k-wires and the Métaizeau technique (n = 16) or open reduction plus internal fixation with k-wire (n = 18). Patient data including sex, age, time from trauma to surgery, fracture type, follow up, postoperative healing time, X-ray studies, elbow function, and complications were collected. Results There were no significant differences in patient characteristics between the two treatment groups. In postoperative elbow function assessment, 93.8% of patients in the group that underwent the novel treatment approach had a score of excellent or good, compared with 83.3% of patients in the open reduction and internal fixation with k-wire group. Furthermore, no postoperative complications were reported in patients in the novel treatment group, compared with 5 patients in the open reduction and internal fixation with k-wire group. All patients in both groups were classified as excellent or good according to Métaizeau criteria in postoperative X-ray assessment. Conclusions Compared with the open reduction and internal fixation with k-wire approach, percutaneous leverage reduction using two k-wires combined with the Métaizeau technique can significantly increase the minimally invasive reduction rate, and represents an attractive strategy for the treatment of Judet IV radial neck fractures in children.

Objective To investigate the clinical effects ofpercutaneous two Kirschner wires leverage reduction combined with Métaizeau's technique in the treatment of children with Judet type Ⅳ radial neck fractures.Methods From January 2013 to June 2016, 16 cases of Judet type Ⅳ radial neck fractures were treated by association of percutaneous two Kirschner wires leverage reduction and Métaizeau's technique.According to the Judet classification, 8 cases were type Ⅳ a and 8 cases were type Ⅳ b.After the operation, the affected arm was fixed using long arm plaster for 3 to 4 weeks.The elastic intramedullary nail was removed 2 to 3 months after the operation.Results All the patients were follow-up for 12 to 39 months with an average of 19 months.Fracture healing time was 4 to 10 weeks with the average being 5.4 weeks.No complications such as avascular necrosis of the radial head, early closure of the epiphyseal plate of proximal radius and bone nonunion occurred.According to Métaizeau's standard, the postoperative X-ray was rated as excellent in 12 cases and good in 4 cases.According to the MEPS elbow function score, the results were excellent in 10 cases,good in 5 cases and fair in 1 case.Conclusion The association of percutaneous two Kirschner wires leverage reduction and Métaizeau's technique in the treatment of children with Judet type Ⅳ radial neck fractures can significantly improve the rate of minimally invasive reduction, with advantages of less trauma, fewer complications, good effect and safety.