儿童后内侧和后外侧移位肱骨髁上骨折和肘内翻畸形之间的关系  

Children medial and lateral displacement of fracture and cubitus varus deformity relationship between supracondylar humerus

作　　者：胡欣[1] 

机构地区：[1]湖南省儿童医院小儿骨科,湖南长沙410007

出　　处：《临床骨科杂志》2014年第4期461-463,共3页Journal of Clinical Orthopaedics

摘　　要：目的：探讨儿童后内侧和后外侧移位肱骨髁上骨折和发生肘内翻畸形之间的关系。方法采用闭合复位克氏针内固定治疗33例Gartland Ⅲ型肱骨髁上骨折患儿（ⅢA型18例,ⅢB型15例）,术后辅以石膏托外固定3～4周。术后在肘关节正、侧位X线片上测量提携角和肘关节的运动范围,观察提携角变化,分析移位方向和肘内翻的关系。结果患儿均获随访,时间1～2年。18例ⅢA型骨折者提携角丢失15.2°±5.1°,15例ⅢB型骨折者提携角丢失8.8°±3.5°。ⅢA型骨折与ⅢB型骨折致肘内翻的程度比较差异有统计学意义（P＜0.05）。患者均未出现肘关节活动受限。根据Flynn标准：18例ⅢA型骨折患儿中10例为良,8例为差；15例ⅢB型骨折患儿中9例为良,6例为差。结论ⅢA型骨折较ⅢB型骨折出现肘内翻的可能性更大。即使术后得到了解剖复位,ⅢA型骨折仍可能导致肘内翻畸形,这可能是ⅢA型骨折中内侧骨皮质的压缩,或伴有骨骺损伤所造成。Objective To investigate the child after the medial and lateral shift after supracondylar fractures and de-formity occurs turn the relationship between the inner elbow. Methods 33 cases of supracondylar fractures were treated with closed reduction and Kirschner wire fixation （ Gartland typeⅢA 18 cases, typeⅢB 15 cases） . Surgery combined with external fixation plaster for 3～4 weeks. After being in the elbow, the lateral X-ray measurement of the carrying angle and elbow range of motion, carrying angle changes observed, analyzed and cubitus varus displacement direction of the relationship. Results The children were followed up for 1～2 years. 18 cases of typeⅢA fracture of the elbow carrying angle lost 15. 2°± 5. 1°, 15 cases of type ⅢB person carrying angle lost 8. 8°±3. 5°. Cubitus varus typeⅢA andⅢB fractures caused a statistically significant difference compared （P〈0. 05）. No patient expe-rienced elbow limited mobility. According to Flynn criteria：18 cases of type Ⅲa fracture patients, 10 cases of be-nign and 8 were poor;15 cases of patients with typeⅢB fracture patients, 9 cases of benign and 6 were poor. Con-clusions Type Ⅲa fractures compared to Ⅲb fractures are more likely to occur cubitus varus. Even after surgery has been anatomically, typeⅢA fractures may still lead to cubitus varus deformity, which may be typeⅢA compres-sion fracture of the medial cortical bone, or accompanied by epiphyseal injuries.

关 键 词：儿童 肘内翻 并发症 肱骨髁上骨折 骨折移位 

分 类 号：R683.41[医药卫生—骨科学] R682.5[医药卫生—外科学]