儿童尺骨冠状突骨骺骨折的临床治疗  

Clinical Treatment of Epiphyseal Fracture of Coronoid Process of Ulna in Children

作　　者：孙强 叶家军[1] 周英[1] Sun Qiang;Ye Jiajun;Zhou Ying(Department of Pediatric Orthopaedics,Sichuan Orthopaedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院儿童骨科,四川成都610041

出　　处：《实用骨科杂志》2024年第6期486-489,513,共5页Journal of Practical Orthopaedics

基　　金：四川省医学科研课题(S19065);2023年度成都市医学科研课题(2023450);四川省名中医周英工作室活态传承建设项目(川中医药办发[2022]16号)。

摘　　要：目的探讨儿童尺骨冠状突骨骺骨折的特点与临床治疗方案。方法回顾性分析2014年1月至2023年1月四川省骨科医院儿童骨科收治的尺骨冠状突骨骺骨折102例患儿资料,男82例,女20例;左侧54例,右侧48例;年龄1岁11个月~14岁6个月,平均(9.53±3.27)岁。按Regan-Morrey分型,Ⅰ型49例,Ⅱ型27例,Ⅲ型26例。伴肘关节脱位39例,伴其他部位骨折75例。保守治疗59例,手术治疗43例。手术固定材料:空心钉+克氏针10例,克氏针9例,钢板24例。结果所有患儿均获得随访,随访时间10个月~4年9个月,平均(30.02±8.77)个月。按Mayo肘关节功能评价标准评定,优81例,良17例,可4例,优良率96.08%。结论儿童尺骨冠状突骨骺骨折常伴随其他骨折、肘关节脱位,预防漏诊需详溯病史及分析受伤机制,细致查体,摄伤肢X线片、CT平扫或MRI,Regan-MorreyⅠ型和骨折块小、移位少且肘关节稳定的骨折可采取保守治疗,粉碎性骨折、合并肘关节失稳的Regan-MorreyⅡ型及Ⅲ型骨折更推荐前侧入路微型“T”型锁定钢板、空心钉或克氏针内固定,后期预后均较好。Objective To explore the characteristics and clinical treatment of ulnar coronal process epiphyseal fractures in children.Methods A retrospective analysis was performed on 102 children with ulnar coronal process epiphyseal fractures admitted to the Children's Orthopaedics Department of Sichuan Orthopaedics Hospital from January 2014 to January 2023.The cohort comprised 82 males and 20 females,with 54 fractures on the left side and 48 on the right.The age range was from 1 year,11 months to 14 years,6 months,with an average age of(9.53±3.27)years.Based on the Regan Morrey classification,there were 49 cases of typeⅠ,27 cases of typeⅡ,and 26 cases of typeⅢfractures.Among these cases,39 were accompanied by elbow joint dislocation,and 75 were accompanied by fractures in other body parts.Fifty-nine cases underwent conservative treatment,while 43 cases underwent surgical intervention.Surgical fixation materials included a combination of hollow nails and Kirschner wires in 10 cases,Kirschner wires alone in 9 cases,and steel plates in 24 cases.Results All patients were followed up for a duration ranging from 10 months to 4 years and 9 months,with an average follow-up period of(30.02±8.77)months.Based on the Mayo elbow joint function evaluation criteria,the outcomes were classified as 81 excellent cases,17 good cases,and 4 fair cases,resulting in an excellent and good rate of 96.08%.Conclusion Coronary process epiphyseal fractures of the ulna in children are frequently accompanied by additional fractures and elbow joint dislocations.To avoid misdiagnosis,it is crucial to thoroughly investigate the patient's medical history and injury mechanisms,conduct a detailed physical examination,capture lateral images of the injured limb,and perform a CT plain scan or MRI.For Regan-Morrey type I fractures and those with small fragments,minimal displacement,and a stable elbow joint,conservative treatment is often adopted.However,for comminuted fractures such as Regan-Morrey typeⅡandⅢfractures,accompanied by elbow instability

关 键 词：儿童 尺骨冠状突骨骺骨折 内固定 

分 类 号：R683.41[医药卫生—骨科学]