切开复位后方加压埋头钉固定治疗儿童肱骨小头骨折疗效评价  

Outcomes of posterior open reduction plus internal fixation of capitellar fractures in children

作　　者：姚杰[1] 申向阳 贾国强 Yao Jie;Shen Xiangyang;Jia Guoqiang(Department of Orthopedics,Anhui Provincial Children's Hospital,Anhui Medical University,Hefei 230051,China)

机构地区：[1]安徽医科大学附属省儿童医院骨科,合肥230051

出　　处：《临床小儿外科杂志》2024年第3期254-257,共4页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金面上项目(61976008);安徽医科大学基金项目(2022xkj111)

摘　　要：目的探讨切开复位后方加压埋头钉固定治疗儿童肱骨小头骨折的手术疗效。方法本研究为回顾性研究,收集安徽医科大学附属省儿童医院骨科2018年12月到2022年1月收治的冠状面肱骨小头骨折行切开复位后方加压埋头钉固定患儿的临床资料,共14例。其中男13例、女1例;左侧10例、右侧4例;年龄(13.47±1.31)岁;受伤距手术时间(2.61±1.32)d,术前均根据CT及三维重建结果判断骨折分型。根据Bryan-Morrey分型标准:Ⅰ型8例,Ⅳ型6例;根据美国波士顿儿童医院分型均为冠状面剪切型Ⅰb骨折。均采取Kocher入路切开复位后方加压埋头钉固定。肘关节功能评价标准采用Mayo和Quick-DASH标准。末次随访时根据X线片评估肱骨小头骨折愈合情况、外形、有无坏死、关节面是否平整以及有无骨性关节炎等。结果14例患儿术中出血量(36.67±15.60)mL、透视次数(9.32±5.37)次、切口长度(5.54±1.93)cm、住院天数(7.06±2.45)d、手术时间(64.38±12.84)min。随访时间(31.04±4.05)个月,随访期间无一例发生感染、内固定松动、石膏压疮等近期并发症。肘关节Mayo评分(94.62±3.31)分。末次随访时所有患儿关节面平整,肱骨小头外形正常,无一例发生骨不连、肱骨小头坏死、骨关节炎、关节功能明显受限等并发症。结论冠状面剪切型肱骨小头骨折早期行切开复位后方加压埋头钉固定治疗,具有创伤小、并发症少、术后功能恢复好等优点。Objective To explore the efficacy of open reduction plus internal fixation with compression screws for pediatric capitellum fracture.Methods From December 2018 to January 2022,the relevant clinical data were retrospectively reviewed for 14 children hospitalized with coronal capitellum fracture.There were 13 boys and 1 girl with an average age of(13.47±1.31)(10-15)year.The involved side was left(n=10)and right(n=4).The time from injury to operation was(2.61±1.32)day.Imaging studies of computed tomography(CT)and three-dimensional reconstruction pre-operation were examined.According to the Bryan Morrey classification scheme,the clinical types wereⅠ(n=8)andⅣ(n=6).According to the criteria of Boston Children's Hospital,all fractures belonged to coronal shear typeⅠb.Open reduction was performed via Kocher approach and compression screw fixation.Elbow function was evaluated by Mayo and Quick DASH standards.At the last follow-up,healing,appearance,necrosis,smoothness of articular surface and osteoarthritis of capitellum fracture were evaluated by radiography.Results The perioperative parameters were intraoperative volume of blood loss(36.67±15.60)ml,fluoroscopic frequency(9.32±5.37),incision length(5.54±1.93)cm,hospitalization stay(7.06±2.45)day and operative duration(64.38±12.84)min.During an average follow-up period of(31.04±4.05)month,there was no occurrence of infection,internal fixation loosening or plaster pressure sore.Mayo score of elbow joint was(94.62±3.31)point.At the last follow-up,there were smooth articular surface and normal anatomy of capitellum.There was no onset of nonunion,necrosis of capitellum humeri,osteoarthritis or joint function limitation.Conclusions Early open reduction plus compression countersunk nail internal fixation of coronary shear capitellum fracture is mini-invasive with minimal injury to articular cartilage.With rapid functional recovery,it offers excellent short-term outcomes.

关 键 词：肱骨小头 骨折 外科手术 儿童 

分 类 号：R726.8[医药卫生—儿科]