儿童肱骨外髁骨折骨不连的治疗

Treatment of nonunion of the lateral humeral condyle fractures in children

目的探讨儿童肱骨外髁骨折骨不连的治疗方法。方法对13例肱骨外髁骨折骨不连进行诊治。患儿年龄平均10．5岁（6～14岁），受伤至就诊时间平均6．7年（0．9～10年）。其中MilchⅠ型3例（X线片表现为肱骨外髁骨块较小、桡骨小头呈圆形、肱骨小头凹陷），MilchⅡ型10例（X线片表现为肱骨外髁骨块较大、肱桡关节结构近似正常）。13例中行单纯骨折切开复位内固定术1例，游离髂骨植骨内固定术3例，游离髂骨植骨内固定＋尺神经松解前置术1例，游离髂骨植骨内固定＋肱骨髁上楔形截骨术5例，游离髂骨植骨内固定＋肱骨髁上楔形截骨＋尺神经松解前置术3例。结果术后随访时间平均为5．6年（2．2～12年）。除2例患者骨延迟愈合外，其余患者均达到骨愈合。术前疼痛症状及肘关节不稳消失。患手握力恢复至健侧的87％（84％～100％）。3例肘关节屈伸活动度得到明显改善，平均改善47．7°（30°～58°）；2例肘关节屈伸活动度无明显改善；8例肘关节屈伸活动度与术前相比有所下降，平均下降16°（8°～30°）。13例中除2例肘外翻角度增加和2例继发肘内翻外，其余9例提携角平均下降14．2°。按Bmberg肘关节功能评分系统评定：优7例，良6例；优良率为100％。结论儿童肱骨外髁骨折骨不连可行外科手术治疗，骨折切开复位、植骨内固定术是确实且有效的治疗方法。

Objective To summarize the treatment experience of nonunion of the laterul humeral condyle fractures in children, and provide a rehable and predictable treatmem method. Methods Thirteen pediatric patients with nonunion of fractures of the lateral humeral condyle were included in this study. There were 10 boys and 3 girls with an average age of 10.5 years （range, 6 to 14 years）. Duration from injury to presentation averaged at 6.7 years （range, 9 months to 10 years）. The average follow-up period was 5.6 years （range, 2.2 years to 12 years）. According to Broberg functional rating index, elbow function was excellent in 1 case, good in 6, fair in 4 and poor in 2. The patients were treated surgically with ORIF （ open reduction and internal fixation） in 1 case, OR.IF ＋ IBG （ fliac bone graft） in 3, ORIF ＋ IBG ＋ ATUN （ anterior transposition of the ulnar nerve） in 1, ORIF ＋ IBG ＋ GOH （ corrective osteotomy of the humerus） in 5 and ORIF ＋ IBG ＋ COH ＋ ATUN in 3, respectively. Results All the patients achieved bone healing but 2 with delayed union. Pain, elbow instability and ulnar nerve palsy disappeared in all cases postoperatively. The grip strength returned to 87% of the healthy side on average（range, 84% to 100% ）. ROM （rang of motion） was improved in 3 cases at an average of 47.7° （ range, 30° to 58°）, unchanged in 2 cases, and decreased in 8 cases at an average of 16° （range, 8° to 30°） , respectively. The carrying angles increased in 2 cases, and decreased in 9 cases with cubitus varus deformity in 2 cases. According to the Broberg functional rating index, the score increased in 12 cases with an average increase of 19.4. Only one dropped from 99 points to 88. Elbow function was evaluated as excellent in 7 cases and good in 6. Conclusion Nonunion of fractures of the lateral humeral condyle can be treated successfully by surgery. ORIF ＋ IBG is a reliable and efficient treatment method.