Papavasiliou和CrawfordⅣ型儿童肱骨内上髁骨折治疗效果的研究分析  

Outcomes of children with medial epicondyle humeral fractures Papavasiliou&Crawford typeⅣ

作　　者：庄俊涛 庞浩田 范民杰 王亦维 郑朋飞 Zhuang Juntao;Pang Haotian;Fan Minjie;Wang Yiwei;Zheng Pengfei(Department of Orthopedics,Children's Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院骨科,南京210000

出　　处：《中华小儿外科杂志》2022年第12期1119-1124,共6页Chinese Journal of Pediatric Surgery

基　　金：江苏省重点研发计划(社会发展)项目(BE2019608)。

摘　　要：目的比较合并肘关节脱位(Papavasiliou和Crawford分型Ⅳ型)与无肘关节脱位(Ⅱ型和Ⅲ型)儿童肱骨内上髁骨折治疗效果。方法回顾性分析2014年1月至2019年12月在南京医科大学附属儿童医院因移位性肱骨内上髁骨折需行手术治疗的101例患儿资料,其中男54例,女47例,年龄(9.5±3.4)岁,年龄范围5~14岁。根据是否合并肘关节脱位分为两组,A组为单纯肱骨内上髁骨折共75例;B组为肱骨内上髁骨折合并肘关节脱位共26例。A组患儿行骨折切开复位克氏针固定术,B组患儿均急诊行手法复位肘关节脱位,后期行骨折切开复位克氏针固定术。术后定期随访,记录患儿尺神经损伤、肘关节疼痛等临床资料,肘关节X线正侧位片进行影像学评估,Robert功能评分评估比较两组患儿肘关节功能。结果A组和B组术前有尺神经损伤症状患儿分别为21例和9例。术后A组尺神经损伤症状有15例,其中新增2例;B组尺神经损伤症状术后有8例,其中新增1例。两组患儿均6个月全部恢复。末次随访时影像学资料显示两组患儿肘关节解剖关系匹配良好、无脱位复发、无滑车缺血坏死及骺板早闭发生。根据Robert功能评分,A组中,优39例,良22例,可11例,差3例。B组中,优11例,良9例,可4例,差2例。两组间Robert功能评分差异无统计学意义(P>0.05)。结论经手术治疗的儿童移位性肱骨内上髁骨折无论是否合并肘关节脱位都具有良好的影像和功能转归。Objective To compare the therapeutic efficacies of medial epicondylar humeral fracture in children with elbow dislocation(Papavasiliou&Crawford typeⅣ)and without elbow dislocation(type II/III).Methods From January 2014 to December 2019,clinical data were retrospectively reviewed for 101 children operated for displaced medial epicondylar humeral fractures.There were 54 males and 47 females with a median age of(9.5±3.4)(5-14)years.According to the presence or absence of elbow dislocation,they were divided into group A(n=75)with simple medial epicondylar fracture and group B(n=26)with medial epicondylar fracture plus elbow dislocation.Group A underwent open reduction plus Kirschner wire fixation and group B underwent emergency manual reduction for elbow dislocation and subsequent open reduction plus Kirschner wire fixation.After regular postoperative follow-ups,clinical observations of ulnar nerve injury and elbow joint pain were recorded.Anteroposterior and lateral radiology of elbow joint was employed for imaging evaluations.Robert's functional score was utilized for comparing elbow joint functions between two groups.Results There were 21 and 9 children with preoperative symptoms of ulnar nerve injury in groups A and B.Among 15 cases of ulnar nerve injury in group A post-operation,2 cases were new;among 8 cases of ulnar nerve injury in group B post-operation,1 case was new.Both groups recovered within 6 months.Imaging data at the last follow-up showed that elbow joint anatomy of two groups matched well,without dislocation recurrence,trochlear ischemic necrosis or premature closure of physis.According to Robert's functional score,in group A,39 patients were excellent,22 good,11 fair and 3 poor.In group B,11 patients were excellent,9 good,4 fair and 2 poor.No significant inter-group difference existed in Robert function score(P>0.05).Conclusions Surgery is efficacious for children with medial epicondyle fractures with or without concurrent elbow dislocation.Both radiological and functional outcomes are excellent.

关 键 词：肱骨 儿童 肱骨内上髁骨折 肘关节脱位 治疗 

分 类 号：R726.8[医药卫生—儿科]