儿童Gartland ⅡA伸直型肱骨髁上骨折肘关节屈曲功能丢失角度评估的X线影像模拟研究  

A simulation study on loss of elbow flexion in children with GartlandⅡA supracondylarhumeral fractures

作　　者：刘祥飞 王恩波[1] 贾国强[1] 刘天婧[1] 陈佳元 Liu Xiangfei;Wang Enbo;Jia Guoqiang;Liu Tianjing;Chen Jiayuan(Department of Pediatric Orthopedics,Affiliated Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿骨科,沈阳110004

出　　处：《中华小儿外科杂志》2020年第11期1016-1020,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨利用肘关节侧位X线片肱骨前缘线与肱骨小头骨化中心的关系,评估儿童GartlandⅡA伸直型肱骨髁上骨折即时屈肘功能丢失角度的可能。方法通过医院PACS系统筛选2008年1月到2020年3月拍摄的1~14岁患儿中包含肘关节标准侧位片的正常肘关节X线片,并将图像导入Adobe Photoshop 14.0软件,认为制造矢状面倾斜角度不同的骨折线,并模拟GartlandⅡA伸直型肱骨髁上骨折后远折端矢状面旋转,记录远折端旋转角度即为肘关节屈曲功能丢失角,并每3岁为一组进行分层,分析肘关节屈曲功能丢失角与年龄及骨折线角度之间的关系。结果儿童GartlandⅡA型肱骨髁上骨折后,远折端旋转至肱骨小头骨化中心与肱骨前缘线相切时,屈肘功能角约丢失19.4°±4.9°,范围在11°~30°。1~3岁、4~6岁、7~9岁、10~12岁、13~14岁组平均屈肘功能丢失角度分别为14.3°±4.2°、18.4°±3.6°、20.6°±3.6°、20.7°±4.0°和24.0°±4.8°,组间比较,除7~9岁和10~12岁组间差异无统计学意义外,其余各组屈肘功能丢失角度比较,差异均有统计学意义(P均<0.05)。肘关节屈肘功能丢失角度年龄趋势图显示,在相同年龄下骨折线角度为0时屈肘功能丢失角度最多,且随年龄增大屈肘功能丢失角度有增加趋势。骨折线角度及年龄与屈肘功能丢失角度之间的相关性分析显示,在控制变量为骨折线角度时,年龄与屈肘功能丢失角度之间存在正相关关系,其相关性为0.731(P<0.05);在控制变量为年龄时,骨折线角度与屈肘功能丢失角度间存在负相关关系,其相关性为-0.739(P<0.05)。结论儿童GartlandⅡA伸直型肱骨髁上骨折后,屈肘功能丢失角度会随患儿年龄增大而增大,随骨折线矢状面倾斜角度增加而减小。如果肱骨前缘线与肱骨小头骨化中心前缘相切,屈肘功能即时丢失约19°。Objective To assess the immediate loss of elbow flexion after GartlandⅡA supracondylar humeral fractures according to the relationship between anterior margin line of humerus and capitellum in lateral view.Methods Standard lateral views of elbows of children aged 1 to 14 years were collected from the institutional PACS system from Jan.2008 to March 2020.Adobe Photoshop 14.0 was utilized for simulating GartlandⅡA supracondylar humeral fractures with different degrees of angulation and rotation in sagittal plane based upon images.Loss of elbow flexion was represented by the rotation of distal part of fracture.All data were grouped at an age interval of 3 years and the relationship between loss of elbow flexion,age and angulation of fracture was analyzed.Results A mean loss in elbow flexion was(19.4°±4.9°)(11°-30°).And loss occurred when anterior margin line of humerus became tangent to ossification center of capitellum.The mean loss in groups of 1-3,4-6,7-9,10-12 and 13-14 years were 14.3°±4.2°,18.4°±3.6°,20.6°±3.6°,20.7°±4.0°and 24.0°±4.8°respectively.The differences among these groups were statistically significant except in groups of 7-9 and 10-12 years.The changing trend of angle of elbow flexion loss with age hinted at most losses of elbow flexion in 0 at the same age and it increased with increasing age.Positive correlation existed between age and loss angle of elbow flexion when variable was angulation of fracture.However,a negative correlation existed between loss of elbow flexion and angulation of fracture when variable was age.Conclusions Loss in elbow flexion after GartlandⅡA supracondylar humeral fracture increases with age and decreases with angulation in sagittal plane.When anterior margin of humerus becomes tangent to the ossification center of capitellum,there is a loss of 19°in elbow flexion.

关 键 词：儿童 伸直型肱骨髁上骨折 肘关节 关节功能 

分 类 号：R726.8[医药卫生—儿科]