儿童肘关节脱位并肘部骨折的形态特征及治疗  

Morphology and treatment of elbow dislocation associated with elbow fracture in children

作　　者：张天久[1] 俞松[1] 杨小红[1] 吕欣[1] 徐艳朋[1] 罗宇[1] Zhang Tianjiu Yu Song Yang Xiaohong Lyu Xin Xu Yanpeng Luo Yu(Department of Pediatric Orthopedics, the Affiliated Hospital of Zunyi Medical College, Zunyi 563000, Guizhou Province, Chin)

机构地区：[1]遵义医学院附属医院小儿骨科,563000

出　　处：《中华实用儿科临床杂志》2017年第19期1500-1502,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨儿童肘关节脱位并肘部骨折的损伤机制、形态特征和治疗方法。方法回顾性分析遵义医学院附属医院小儿骨科2010年1月至2016年9月收治的12例肘关节脱位并肘部骨折患儿的临床资料。其中男9例，女3例；年龄3．6～12．0岁，平均7．6岁；受伤时间6h～32d，平均3．5d。按肘关节脱位方向分为后侧脱位6例，后外侧脱位4例，前侧脱位2例；12例均为高能量损伤所致，伴前臂暴力旋转性损伤，其中5例为车祸伤，4例为高处坠落伤，2例为电动机皮带绞伤，1例为洗衣机绞伤。12例均行手术治疗，复位肘关节，骨折用克氏针或张力带钢丝固定，修复肘关节侧副韧带。结果所有病例术后随访6—23个月，平均13．5个月。末次随访时肘关节稳定性好，肘部骨折骨性愈合，无肘关节再脱位；肘关节功能恢复满意，伸屈活动度为90°～145°，平均125°，旋转活动度为85°～155°，平均130°，按Mayo肘关节功能评定标准：优7例，良4例，优良率91．7％（11／12例）。结论儿童肘关节脱位多由高能量损伤及前臂暴力旋转性损伤所致，极易合并不同类型的肘部骨折和严重的肘关节侧副韧带损伤，应积极手术治疗，恢复肘关节的正常解剖关系，重建肘关节的稳定性，恢复肘关节功能。Objective To investigate the morphological characteristics of elbow dislocation associated with elbow fracture in children, to propose its injury mechanism, and to present its treatment and outcomes. Methods From January 2010 to September 2016 in Department of Pediatric Orthopedics ,the Affiliated Hospital of Zunyi Medical College, the clinical data of elbow dislocation associated with elbow fracture were retrospectively analyzed in 12 children, in which there were 9 boys and 3 girls with a mean age of 7.6 （3.6 - 12.0） years, and the injury time was 6 h - 32 days, with an average of 3.5 days. According to the direction of dislocation, posterior dislocation in 6 cases, posterolateral dis- location in 4 cases, and anterior dislocation in 2 cases. Twelve cases were caused by high energy injury, accompanied with violent rotary injury of forearm, including traffic accident injury in 5 cases, high fall injury in 4 cases, motor belt in- jury in 2 cases, and washing machine injury in 1 case. All these cases were treated with surgery, the dislocated elbow joint were reset,the fracture fragments were fixed with Kirschner wire or wire tension band, and the lateral collateral ligament were repaired. Results All cases were followed up for 6 -23 months, with an average 13.5 months. The sta- bility of elbow joint and the fracture healing were very good, and no elbow redislocation at the last follow - up. The function of elbow joint recovered satisfactorily, the extension - flexion motion ranged from 90° - 145°, with an average of 125°,and the pronation- supination motion ranged from 85° - 155° ,with an average of 130°. According to the Mayo functional index, the results were excellent in 7 cases and good in 4 cases, and the excellent and good ratio was 91.7 % （11/12 cases）. Conclusions The elbow dislocation of children is caused by high energy injuries and the violent rotational injury of the forearm, easily combined with different types of elbow fractures and severe injury of collateral ligament. Surgical treatme

关 键 词：儿童 肘关节脱位 骨折 形态特征 治疗 

分 类 号：R687.3[医药卫生—骨科学]