儿童肱骨外髁骨折834例治疗分析

Treatment of Lateral Condylar Fracture of Humerus in Children

目的探讨儿童肱骨外髁骨折诊治及并发症的预防。方法701例Ⅰ型骨折进行非手术治疗，673例非手术治疗成功，28例5～15d发现骨片移位接受手术治疗；59例Ⅱ型骨折，2例非手术治疗，49例手术治疗；62例Ⅲ型和Ⅳ型骨折，8例陈旧性骨折病例手术治疗，总共147例手术；12例放弃治疗。结果非手术治疗的骨折病例中，1例Ⅱ型骨折病例出现肘内翻；139例急性、亚急性手术病例，22例轻度肱骨外髁隆凸，5例轻度肘关节功能受限，1例肱骨小头及滑车坏死，1例内固定感染骨髓炎；8例手术治疗的陈旧性病例，5例效果满意，2例肘关节功能受限，1例骨不连。结论儿童肱骨外髁骨折治疗的关键是争取早期解剖复位，防止陈旧性骨折的发生。

Objective To investigate the diagnosis and treatment of lateral condylar fracture of humerus in children. Methods A total of 673 type Ⅰ patients were managed with conservative treatment suecessfully while 28 type Ⅰ patients, 49 type Ⅱ patients, all type Ⅲ, type Ⅳ and old fracture patients were treated with open reduction and internal fixation. Results Onetype Ⅱ patient managed with conservative treatment had eubitus varus. In the patients undergoing emergency operations, the complications of open reduction included the mild protuberance of the lateral condyle in 22 patients, the mild limitation of elbow movement in 5 patients, the osteoneerosis in 1 patient and osteomyelitis in 1 patient. Five old fracture patients had good results, 2 old fracture patients had limitation of elbow movement and 1 had nonunion. Conclusion The key of treatment is the anatomic reduction of the fracture and prevention of the occurrence of the old fracture.