儿童肱骨外髁骨折后遗畸形的手术及康复治疗

Open reduction and rehabilitation of the deformity after humeral lateral condyle fractures in children

[目的]探讨儿童肱骨外髁骨折后遗畸形如严重肘外翻、骨不连等的原因及其防治和康复,提高对儿童肱骨外髁骨折的认识。[方法]回顾性总结分析本院2001～2006年间27例肱骨外髁骨折后骨不连、肘外翻畸形的病例,其中男19例,女8例;右侧16例,左侧11例;受伤年龄2～10岁,平均5.6岁;手术年龄5～14岁,平均9岁;受伤至手术时间最短8个月,最长10年,平均2.8年。根据不同情况,共采用3种术式,其中直接行骨折块原位内固定7例,切开复位、髂骨取骨植骨内固定11例,肱骨远端内翻楔形截骨矫形9例。[结果]获得2年以上随访14例,6个月～2年,13例。所有病例均在术后8～16周形成骨愈合,肘部畸形得到不同程度的矫正,肘关节功能得到不同程度恢复,疗效较满意。根据肘部外形、活动功能和并发症分为优、良、差3个等级,其中优13例,良11例,差3例,总优良率为88.9%。术后无骨坏死、创伤性关节炎及骨化性肌炎的发生。[结论]对儿童肱骨外髁骨折认识不足,治疗不及时或治疗方案选择不恰当,是导致骨不连和儿童肱骨外髁骨折后遗畸形如严重肘外翻、骨不连等的主要因素,后遗畸形导致功能障碍,恢复较困难。针对不同的情况早期采取相应的手术方式,辅以多种功能锻炼,能有效改善肘关节的外观和功能。

[Objective]To investigate etiopathogenisis,modus operandi and rehabilitation in treatment of bone nonunion and residual deformity （cubitus valgus） after humeral lateral condyle fractures in children. [Method]The author retrospective summarized a total of 27 patients diagnosed with humeral lateral condyle fracture follow with bone nonunion and/or cubitus valgus consecutive enrolled in Children’s Hospital of Chongqing Medical University from 2001 to 2006,including 19 cases of male,8 cases of female,16 cases of right humeral lateral condyle fracture and 11 cases of left. The mean age at injured for all the patients （n =27） was 5.6 yr （range 3-10 yr）.The mean age at suigical operation for all the patients （n =27） was 9 yr （range 5-14 yr）.The average time from injury to operation was 2.8 yr （range 8mon-10 yr）.There were three modus operations including direct normal position internal fixation of 7 cases,open reduction following os illium bone graft internal fixation of 11 cases,distant humerus varus wedge shape cut orthopaedic for 9 cases.[Result]Thirteen patients were followed up ranging from 6 month to 2 years,and 14 patients over 2 years. All the patients were achieved union for 8 to 16 weeks after surgery. Elbow deformity had been corrected and function of elbow joint had been recoverd satisfactorily. All of them,excellent rerult were found in 13 cases,good in 11 cases,and poor in 3 cases,the excellent and good rates was 88.9%. None of the cases happened with osteonecrosis,traumatic arthritis and myositis ossificans.[Conclusion]It is common that delay treatment of humeral lateral condyle fractures in children can result in bone nonunion and residual deformity （cubitus valgus） and it is difficult for treatment. Corresponding surgical treatment with different condition and early exercise can improve the appearance and function of elbow joint.