儿童伸直型髁上骨折发生肘内翻的原因分析

Analysis on the causes of cubitus varus in pediatric extension type supracondyiar fracture of humerus

目的 探讨儿童伸直型髁上骨折发生肘内翻的可能原因.方法 回顾性分析临床明确诊断为伸直型髁上骨折的244例患儿的临床资料.Ⅰ型骨折60例,其中尺偏型28例,桡偏型32例,采用闭合复位石膏固定治疗.Ⅱ型骨折56例,其中尺侧损伤偏重25例,桡侧损伤偏重31例,采用闭合复位石膏固定治疗.Ⅲ型骨折128例,均手术治疗,其中63例行肘内侧入路手术,32例行肘外侧入路手术,33例行内外侧小切口双侧入路手术.合并神经血管损伤23例,无血管神经损伤221例.治疗6个月后观察肘内翻发生率.结果 Ⅰ型骨折尺偏型肘内翻发生率明显高于桡偏型（P＜0.05）;Ⅱ型骨折尺侧损伤重者肘内翻发生率明显高于桡侧损伤重者（P＜0.05）;Ⅲ型骨折外侧入路肘内翻发生率明显高于内侧入路及双侧入路（P＜0.01）.伴有血管神经损伤者术后肘内翻发生率明显高于无血管神经损伤者（P＜0.01）.GartlandⅡ型骨折术后肘内翻率高于Gartland Ⅰ、Ⅲ型（P＜0.05）.结论 儿童伸直型髁上骨折发生肘内翻的原因复杂,合理有效的治疗可降低肘内翻发生率,但无法避免.

Objective To explore the possible causes of cubitus varus in pediatric extension type supracondyiar fracture of humerus. Methods The clinical data of 244 cases of children clinically diagnosed as extension type supra condylar fractures were retrospectively analyzed. 60 cases were type I fracture, including 28 cases with ulnar deviation and 32 cases of radial deviation. They were treated by closed reduction with plaster cast immobilization. 56 cases were type II fracture, including 25 cases with more serious injury on the ulnar side and 32 cases with more serious injury on the radial side. They were also treated by closed reduction with piaster cast immobilization. 128 cases were type Ill frac ture, all of whom received operation, including 63 cases with medial approach to the elbow, 32 cases with lateral ap proach to the elbow, and 33 cases with small incisions from the medial and lateral approach to the elbow. 23 cases were complicated with neurovascular injury and 221 cases without nenrovascular injury. The incidence of cubitus varus was ob served at 6 months after treatment. Results The incidence of cubitus varus was higher in type I fracture with ulnar de viation than those with radial deviation （ P 〈 0.05 ）. The incidence of cubitus varus was higher in type fracture with more serious injury on the ulnar side than those with more serious injury on the radial side （ P 〈 0.05 ）. The incidence of cubitus varus was higher in type fracture with lateral approach to the elbow than those with medial or bilateral approach to the elbow （ P 〈 0.01 ）. The incidence of cubitus varus was higher in those with neurovascular injury than those without neurovascular injury （P 〈0.01 ）. The incidence of postoperative eubitus varus was higher in Gartland supracondylar fracture than those with Gartland I and supracondylar fracture （P 〈 0.05）. Conclusion The causes of the cubitus varus in pediatric extension type supracondylar fractures are complex. Rational and effective treatment can reduce the in cidence of cubitus varus, but it can not be avoided.