儿童肱骨外髁骨折合并尺骨鹰嘴和冠状突骨折的危险因素分析  

Risk factors for the lateral condyle fracture of the humerus concomitant with fractures of ulna olecranon and coronoid in children

作　　者：余京杭 李连永[1] Yu Jinghang;Li Lianyong(Department of Pediatric Orthopaedics,Shengjing Hospital of 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：《中华创伤骨科杂志》2024年第5期404-409,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的分析儿童肱骨外髁骨折合并尺骨鹰嘴和冠状突骨折(三联骨折)的危险因素。方法回顾性分析2012年1月至2022年12月在中国医科大学附属盛京医院小儿骨科因肱骨外髁骨折住院治疗的连续584例患儿资料。男392例,女192例;年龄60.5(43.0,86.0)个月;左327例,右257例。单纯肱骨外髁骨折546例(设为单纯组),肱骨外髁骨折合并尺骨鹰嘴和冠状突骨折38例(设为三联组)。记录三联骨折组的治疗方式,末次随访时采用Mayo肘关节功能评分(MEPS)对三联组患儿肘关节功能进行评价。先对两组患儿的性别、侧别、手术年龄、身高、体重、外髁骨折的Jacob分型、Milch分型的分布进行单因素分析。将筛选出的P<0.1的因素纳入进行logistic回归分析,筛选最终变量。结果所有肱骨外髁骨折均行闭合或切开复位克氏针内固定。三联组38例患儿术后获15.0(13.0,21.3)个月随访。均未出现骨不连、畸形愈合、缺血性坏死、肘外翻或迟发性尺神经麻痹等严重并发症。末次随访时MEPS评分为97.5(95.0,100.0)分。单因素分析结果显示:手术年龄(P=0.087)、Jacob分型(P=0.044)和Milch分型(P<0.001)是三联骨折的风险因素。logistic回归分析结果显示:Milch分型Ⅰ型是三联骨折的独立危险因素(OR=25.764,95%CI:11.645~57.001,P<0.001)。结论Milch分型Ⅰ型是肱骨外髁三联骨折发生的独立危险因素。Objective To analyze the risk factors for the lateral condyle fracture of the humerus concomitant with fractures of ulna olecranon and coronoid(triple fracture)in children.Methods A retrospective study was conducted to analyze the data of 584 children who had been hospitalized for lateral condyle fracture of the humerus from January 2012 to December 2022 at Department of Pediatric Orthopaedics,Shengjing Hospital of China Medical University.There were 392 males and 192 females with an age of 60.5(43.0,86.0)months,and 327 left and 257 right sides affected.There were 546 cases of simple lateral condyle fracture of the humerus(simple group)and 38 cases of triple lateral condyle fracture of the humerus(triple group).The treatment methods for the triple group were recorded,and the elbow function of the children in the triple group was assessed using the Mayo Elbow Performance Score(MEPS)at the last follow-up.First,a univariate analysis was conducted of the gender,side profile,surgical age,height,weight,and distribution of the Jacob and Milch types of the lateral condyle of the humerus in the 2 groups.Next,the P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables.Results All the fractures of the lateral condyle of the humerus were treated by internal fixation with Kirschner wires after closed or open reduction.The 38 patients in the triple group were followed up for 15.0(13.0,21.3)months after surgery.There were no such serious complications as bone nonunion,malunion,ischemic necrosis,cubitus valgus,or delayed ulnar nerve paralysis.At the last follow-up,the MEPS score was 97.5(95.0,100.0)points.The univariate analysis showed that surgical age(P=0.087),Jacob type(P=0.044)and Milch type(P<0.001)were the risk factors for a triple fracture.The multivariate logistic regression analysis showed that Milch type Ⅰ was an independent risk factor for a triple fracture(OR=25.764,95%CI:11.645 to 57.001,P<0.001).Conclusion Milch typeⅠis an independent risk factor for

关 键 词：儿童 肘关节 危险因素 肱骨外髁骨折 尺骨鹰嘴骨折 冠状突骨折 

分 类 号：R726.8[医药卫生—儿科]