手术治疗儿童肱骨远端全骺分离197例疗效分析  

Surgical treatment for 197 children with distal humerus epiphysiolysis fracture

作　　者：周海[1] 李明[1] 

机构地区：[1]重庆医科大学附属儿童医院骨科中心,儿童发育疾病研究省部共建教育部重点实验室,重庆400014

出　　处：《重庆医科大学学报》2015年第2期226-229,共4页Journal of Chongqing Medical University

摘　　要：目的：总结分析儿童肱骨远端全骺分离损伤特点及诊断要点,探讨手术治疗的方法、意义及相关问题的处理。方法：2004至2012年,收治197例肱骨远端全骺分离患儿,按Delee分型：A型5例,B型138例,C型54例,伤后24 h内就诊115例,伤后1~7 d就诊69例,超过7 d就诊13例,均采取肘前入路切开复位克氏针内固定,术后24 h拍片复查,4~6周拔除克氏针进行功能锻炼。结果：本组197例,随访时间6月~2年,平均15个月,骨折愈合拔针时间4~6周,平均5周。肘关节功能评价按Flynn等标准进行,优179例,良11例,中4例,差3例,优良率96.4%。肘关节屈伸活动良好,3例出现肘内翻畸形。优良率96.4%。7 d内手术患儿的关节功能优良率高于超过7 d手术的患儿,2组患儿比较差异有统计学意义（P〈0.05）。结论：肘前入路切开复位克氏针内固定治疗儿童肱骨远端全骺分离,具有操作简单,骨折复位容易,可以解剖复位骨折端,尽可能减少肘内外翻畸形的发生,最大程度保留患肢功能。Objective：To analyze the characteristics and key diagnosis points of children humerus distal epiphysiolysis fracture;to study the surgical treatment methods,significance and related issues. Methods：From 2004-2012,197 children with distal humerus epiphysiolysis were received and cured. According to the Delee standards：there were 5 cases of type A,138 cases of type B and 54 cases of type C. Totally 115 cases were cured within 24 h after the injury,69 cases were cured within 1-7 d and 13 cases were cured over 7 d. All children were operated by open reduction and internal fixation through the anterior elbow approach. X-ray was performed after surgery within 24 h. Kirschner wire was removed and excises were started within 4-6 weeks. Results：Totally 197 children were followed up for 6 months to 2 years with an average of 15 months. Kirschner wire was removed within 4-5 weeks with an average of 5weeks. According to the Flynn standards,elbow function was evaluated：179 cases were excellent,11 cases were good,4 cases were fair,3 cases were bad and the excellent and good rate was 96.4%. Children underwent surgery within 7 d had higher excellent and good rate than those underwent surgery over 7 d,with statistical difference between two groups（P0.05）. Conclusion：Treating child humerus distal epiphysiolysis fracture through anterior elbow approach is easy to perform. The fracture can be easily restored and the restored fracture can be anatomized. It can reduce the incidence of cubitus varus and cubitus valgus and retain limb function to the greatest extent.

关 键 词：儿童 肱骨远端全骺分离 外科手术 

分 类 号：R726.8[医药卫生—儿科]