儿童陈旧性肱骨外髁骨折的治疗

TREATMENT OF OLD UNITED LATERAL CONDYLE FRACTURES OF HUMERUS IN CHILDREN

目的探讨儿童肱骨外髁骨折治疗的注意事项及对陈旧性肱骨外髁骨折治疗的经验。方法1997年1月～2002年2月，收治儿童陈旧性肱骨外髁骨折13例。其中男11例，女2例；年龄4～11岁，平均7．2岁。3例有明显肘外翻畸形。初期诊断Ⅰ度骨折4例，Ⅱ度骨折5例，诊断不明确或漏诊4例。伸肘障碍13例，受限30～70°，屈肘〉90°；疼痛2例；肘外翻1例；X线片示骨折不愈合10例，畸形愈合3例。12例患儿损伤至手术时间为32～81d，平均56d，行切开复位加钢针内固定术；另1例患儿为受伤后6个月就诊，行切开复位加钢针内固定和植骨术。结果13例均获随访3～8年，平均5．4年。无肘内翻或外翻畸形，5例有外髁部轻度突起畸形。肘部屈伸活动度改善40～70°，平均56°（包括术前屈肘受限），前臂旋转活动好。X线片示术后6-8周骨折愈合，基本恢复关节平面；无骨不连或骨延迟愈合，无无菌性坏死发生。结论肱骨外髁骨折治疗重点在于早诊断、早治疗，避免发生陈旧性骨折。对于陈旧性骨折，尽早手术能有效修复重建肘关节外观和功能。

Objective To analyze the treatment of old united lateral condyle fractures of humerus in children. Methods From .January 1997 to February 2002, 13 cases of old united lateral condyle fractures of humerus were treated. There were 11 boys and 2 girls. Their age was from 4 to 11 years（7. 2 years on average）. The primary diagnosis results were 4 cases of degree Ⅰ fracture, 5 cases of degree Ⅱ fracture and 4 indefinitely diagnosed cases. Elbow extension disorder occurred in 13 cases, which was limited 30-70°. The elbow flexion was limited more than 90°. X-ray films showed 10 nonunion and 3 malunion of fracture. The time from injury to operation was 32 to 81 days （56 days on average） in 12 cases and 6 months in 1 ease. All cases were treated by open reduction and internal fixation. One case was treated combined with implanting bone. Results After a follow-up of 3 to 8 years（5.4 years on average）, no cubitus varus or valgus occurred. Five cases had growth disturbances of the lateral condyle of the distal humerus. The movement of these elbow joints improved from 40° to 70°（56° on average）. The time of clinical bone union was 6 to 8 weeks and no nonunion and delayed union were observed in X-ray films. Conclusion It is important to accurately diagnose for treatment of lateral condyle fractures of the humerus in children so as to reduce the occurrence of malunion of fracture. It can save the joint function and reduce the cosmetic deformity effectively to operate as early as possible.