术中造影监测下闭合复位内固定治疗儿童肱骨髁间骨折  

Intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children

作　　者：宫伟 王建嗣 李炳钻 蔡秀英 揭强 练志平 GONG Wei;WANG Jian-si;LI Bing-zuan;CAI Xiu-ying;JIE Qiang;LIAN Zhi-ping(Department of Pediatric Orthopaedics,Quanzhou Orthopaedic-Traumatological Hospital,Quanzhou 362000,Fujian China)

机构地区：[1]泉州市正骨医院小儿骨科,福建泉州362000

出　　处：《中国骨伤》2021年第9期856-860,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨术中造影监测下闭合复位内固定治疗儿童肱骨髁间骨折的临床疗效。方法:自2013年1月至2018年7月术中造影监测下手术治疗18例儿童肱骨髁间骨折患者,其中男13例,女5例;年龄3~12(8.50±2.57)岁;按照Toniolo&Wilkinson分型,Ⅰ型8例,Ⅱ型10例。术中根据造影显示肱骨远端软骨关节面的断裂情况,行闭合复位内固定,必要时行切开复位内固定。术后6个月采用Mayo肘关节功能评分标准评定患肢临床疗效。结果:18例患儿均在术中行肘关节造影,其中5例软骨关节面未断裂,行闭合复位内固定;11例软骨关节面断裂,但台阶≤2 mm,行闭合复位内固定;2例软骨关节面断裂,且台阶>2 mm,先撬拨复位软骨关节面,1例关节面平整的,行闭合复位内固定;1例关节面不平整的,台阶仍>2 mm,行切开复位内固定。所有患儿术后获得了随访,时间8~26(20.28±4.40)个月。所有患儿骨折获得愈合,时间6~9(7.33±0.77)周。术后6个月Mayo肘关节功能评分为(89.44±11.36)分,其中优12例,良5例,差1例。术后发生肘关节功能障碍1例,其余未发生伤口感染、肘部畸形等并发症。结论:术中造影监测下治疗儿童肱骨髁间骨折,可以减少手术创伤和并发症,及时、清楚地确认软骨关节面的复位效果,促进肘关节功能的恢复。Objective:To investigate clinical effects of intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children.Methods:From January 2013 to July 2018,18 children with intercondylar fracture of humerus were treated by operation,including 13 males and 5 females aged from 3 to 12 years old with an average age of(8.50±2.57)years old.According to Toniolo&Wilkinson classification,8 children were typeⅠand 10 children were typeⅡ.During the operation,closed reduction and internal fixation were performed under the monitoring of intraoperative radiography,open reduction and internal fixation were performed in necessity.Mayo score of elbow joint was used to evaluate clinical effect at 6 months after operation.Results:All children were underwent arthrography monitoring during operation,5 children were treated with closed reduction and internal fixation for intraoperative arthrography found no fracture of articular cartilage,11 children by closed reduction and internal fixation because of fracture of articular cartilage involving the joint space with displacement less than 2 mm,and 2 children by closed or open reduction and internal fixation for fracture of articular cartilage surface with displacement above 2 mm,which 1 child with smooth of joint surface was performed closed reduction and internal fixation,1 child without smooth of joint surface and displacement above 2 mm was performed open reduction and internal fixation.All children were followed up from 8 to 26 months with an average of(20.28±4.40)months.All factures were healed from 6 to 9 weeks with an average of(7.33±0.77)weeks.Postoperative Mayo score of elbow joint at 6 months was(89.44±11.36),and 12 patients got excellent results,5 good and 1 poor.One patient occurred partial limitation of flexion or extension of elbow joint.No elbow deformity and other complications occurred.Conclusion:The treatment of intercondylar fracture of humerus in children under monitoring of intraoperative radio

关 键 词：肱骨骨折 骨折固定术 内 肘关节 关节造影术 儿童 

分 类 号：R683.41[医药卫生—骨科学]