婴幼儿肱骨远端骨折超声诊断及辅助治疗的临床意义

Ultrasonic diagnosis of distal humeral fracture in infants and toddlers and its clinical significance of ancillary treatment

目的探讨超声在婴幼儿肱骨远端骨折的诊断及辅助治疗的临床价值。方法158例患儿接受了超声检查，其中肱骨髁上骨折102例（Gartland Ⅱ型34例；Ⅲ型68例）；肱骨远端全骺离骨折8例；肱骨外髁骨折44例（JacobⅡ型23例；Ⅲ型21例）；肱骨内髁骨折4例；年龄最小3d，最大2岁11个月，平均1岁8个月。从肘关节6个方向探测：冠状面肱桡关节外侧、矢状面前方和后方，肱尺关节内侧、矢状面前方及后方。结果正常情况下肱骨远端骨皮质与骨骺是连续的，或成直线，或成弧线，无阶梯现象，据此可判断骨折的部位及方向。肱桡关节在三个方向上呈现“双乳征”，肱尺关节内侧可见“马鞍征”，后方可见“对勾征”。在肱骨外髁骨折患儿，肱尺关节正常，肱桡关节三个方向上呈异常的阶梯征；在肱骨髁上骨折及肱骨远端全骺离骨折患儿，6个方向均出现异常的阶梯超声现象；在肱骨内髁骨折患儿仅在肱尺关节内侧方出现异常超声。结论超声是一种无创检查技术，可准确判断肱骨远端骨折的类型，有利于防止误诊，指导治疗。特别对全骺离骨折具有诊断优势。手术中通过超声引导，可以指导肱骨远端骨折的手法复位、经皮克氏针固定，减少了患儿及医务人员的X线暴露，具有良好的应用前景。

Objective To explore the diagnostic value of ultrasound and its clinical significance of ancillary treatment in infants and toddlers of distal humeral fracture. Methods Among a total of 158 cases of distal humeral fracture, there were supracondylar fracture of humerus （n = 102） （Gartland Ⅱ 34; Ⅲ 68）, fracture-separation of distal humeral epiphysis （n = 8）, humeral lateral condyle fracture （n = 44） （Jacob Ⅱ 23; Ⅲ 11） and humeral medial epicondyle fracture （n = 4）. The mean age was 20 months （3 days to 35 months）. Detections were made from 6 orientations of lateral humeroradial joint, front and rear of humeroradial joint, interior humeroulnar joint, front and rear of humeroulnar joint. Results Under normal conditions, bone cortex and epiphysis of distal humerus are continuous with a straight line or arc and there is no staircase. It was thus possible to judge the position and direction of fracture. The appearances of humeroradial joint from three directions were similar and resembled a ＂double-breast sign＂. Anteroposteriorly, coronoid and olecranon epiphyses and coronoid fossa appeared anteriorly while olecranon and trochlear epiphyses and olecranon fossa posteriorly, resembling a ＂check-mark sign＂. Medial epicondyle, cubital tunnel and distal humerus appeared collectively as a ＂saddle sign＂. In humeral lateral condyle fracture, humeroulnar joint remains normal. But three directions of humeroradial joint had unusual staircase signs. In supracondylar humerus and distal humerus epiphysis fractures, six directions had unusual staircase signs. In humeral media epicondyle fracture, only inner side of humeroulnar joint had abnormal ultrasound. Conclusions As a noninvasive examination modality, ultrasound can judge the types of distal humeral fracture accurately and avoid a misdiagnosis, especially epiphyseal fracture. It also guides dosed reductions and percutaneous pinning for distal humeral fracture.