儿童及青少年肱骨内上髁合并桡骨颈骨折的诊疗分析  

Diagnosis and treatment of humeral medial epicondyle fracture combined with radial neck fracture in children and adolescents

作　　者：卢育南 林然 吴加漳 陈晋宸 陈添来 黄玉玲 陈顺有 Lu Yunan;Lin Ran;Wu Jiazhang;Chen Jinchen;Chen Tianlai;Huang Yuling;Chen Shunyou(Department of Pediatric Orthopedics,The Second Hospital of Fuzhou(The Second Hospital of Fuzhou Affiliated to Xiamen University,The Third Clinical Medical College of Fujian Medical University),Clinical Research Center of Emergency and Rehabilitation in Orthopaedics&Traumatology in Fujian Province,Fuzhou 350007,China)

机构地区：[1]福州市第二医院(厦门大学附属福州第二医院、福建医科大学第三临床医学院)小儿骨科,福建省创伤骨科急救与康复临床医学研究中心,福州350007

出　　处：《中华创伤骨科杂志》2023年第2期142-146,共5页Chinese Journal of Orthopaedic Trauma

基　　金：福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014);福建省临床重点专科(20220104)。

摘　　要：目的探讨儿童及青少年肱骨内上髁合并桡骨颈骨折的诊疗。方法回顾性分析2015年2月至2021年8月福州市第二医院小儿骨科收治的12例肱骨内上髁合并桡骨颈骨折患儿资料。男6例,女6例;年龄(11.1±2.5)岁。肱骨内上髁骨折根据Papavasiliou分型:Ⅱ型7例,Ⅲ型2例,Ⅳ型3例;桡骨颈骨折根据Judet分型:Ⅰ型3例,Ⅱ型4例,Ⅲ型5例。其中2例JudetⅠ型桡骨颈骨折X线片检查漏诊,经CT检查确诊。内上髁骨折采用切开复位空心钉固定9例,闭合复位克氏针固定3例;桡骨颈骨折采用闭合复位弹性髓内钉固定8例,保守治疗4例。术后采用X线片复查骨折愈合情况,末次随访时测量双侧提携角并采用Kim肘关节功能评分标准(KEPS)评价患肢功能恢复情况,记录相关并发症。结果12例患者术后获(40.0±25.6)个月随访。骨折愈合时间为(6.3±1.2)周。末次随访时测量提携角:患侧为15.5°±2.6°,健侧为14.7°±2.0°,差异无统计学意义(P>0.05);末次随访时KEPS评分:患侧为(96.3±5.3)分,健侧为(98.8±2.3)分,差异无统计学意义(P>0.05)。均未出现切口感染、骨不连、肘外翻、关节僵硬等并发症,术后各向稳定性恢复良好。结论肱骨内上髁合并桡骨颈骨折是一种儿童及青少年特殊的肘关节伸直外翻型损伤,较易漏诊;治疗应以恢复关节匹配及关节稳定性为目标,力求获得良好功能。Objective To explore the diagnosis and treatment of humeral medial epicondyle fracture combined with radial neck fracture in children and adolescents.Methods The clinical data were retro-spectively analyzed of the 12 pediatric patients with fractures of the humeral medial epicondyle plus the radial neck who had been admitted from February 2015 to August 2021 to Department of Pediatric Orthopedics,The Second Hospital of Fuzhou.There were 6 males and 6 females,with an age of(11.1±2.5)years.According to the Papavasiliou classification,the humeral medial epicondyle fractures were typeⅡin 7 cases,typeⅢin 2 cases and typeⅣin 3 cases;according to the Judet classification,the radial neck fractures were typeⅠin 3 cases,typeⅡin 4 cases and typeⅢin 5 cases.Two Judet-Ⅰradial neck fractures were missed by X-ray exam-ination but diagnosed by CT examination.Of the humeral medial epicondylar fractures,9 were treated by open reduction and hollow screwing and 3 by closed reduction and Kirschner wiring.Of the radial neck fractures,8 were treated by closed reduction and elastic intramedullary nailing and 4 conservatively.Fracture healing was followed up by postoperative radiographs.At the last follow-up,the carrying angles were measured,Kim Elbow Function Score(KEPS)was used to evaluate the functional recovery of the injured limb,and related complications were recorded.Results All the 12 patients were followed up for(40.0±25.6)months.Fractures headed after(6.3±1.2)weeks.At the last follow-up,the carrying angle was 15.5°±2.6°on the injured side and 14.7°±2.0°on the healthy side,showing no significant difference(P>0.05);KEPS was(96.3±5.3)points on the injured side and(98.8±2.3)points on the healthy side,showing no significant difference either(P>0.05).No incision infection,bone nonunion,elbow valgus,joint stiffness or other complications were found;the postoperative elbow stability recovered well.Conclusions As the fracture of the humeral medial epicondyle combined with the radial neck fracture is a special ty

关 键 词：儿童 青少年 桡骨骨折 肱骨内上髁 桡骨颈 

分 类 号：R726.8[医药卫生—儿科]