超声检查在移位较小或没有移位的儿童肱骨外髁骨折中的应用

Application of ultrasonography in managing minimally displaced or nondisplaced lateral humeral condyle fractures in children

目的 探讨超声检查对判断移位较小或没有移位的儿童肱骨外髁骨折稳定性的意义。方法 回顾性分析2014年1月至2017年3月就诊的35例移位较小或者没有移位的肱骨外髁骨折患儿的临床资料。其中，男22例，女13例；年龄1岁7个月～11岁。我们对所有患儿均采用肘前部横切面及矢状切面超声检查来判断患儿软骨铰链是否存在：如软骨铰链存在则建议患儿行长臂石膏固定，1周后复查肘关节X线正侧位片；如软骨铰链断裂则建议行经皮钢针内固定术，术后2～3周复查肘关节X线正侧位片；如患儿软骨铰链断裂但又拒绝手术治疗，则行长臂石膏固定，5～7 d后复查肘关节X线正侧位片。结果 对35例患儿行超声检查后发现其中11例患儿软骨铰链存在，24例患儿软骨铰链完全断裂。在软骨铰链完全断裂的24例患儿中有8例家长拒绝手术治疗，我们对这8例患儿行长臂石膏固定后发现其中2例患儿1周后骨折端发生移位，有3例患儿2～3周后骨折端发生移位。11例因软骨铰链存在行石膏固定的患儿及16例因软骨铰链断裂行手术治疗的患儿骨折端均未发生移位，愈合良好。结论 超声检查操作简单，结果准确，无需镇静，易于推广，是判断儿童移位较小或没有移位的肱骨外髁骨折稳定性的理想的检查方法。

Objective To evaluate the significance of ultrasonic examination in determining the stability of minimally displaced or nondisplaced lateral humeral condyle fractures in children.Methods From January 2014 to March 2017, 35 children with minimally displaced or nondisplaced lateral humeral condyle fractures were reviewed. There were 13 girls and 22 boys with an age range of 19-120 months. Transverse cross-section ultrasonography and sagittal section ultrasonography of anterior elbow were used for determining whether or not cartilage hinge was intact. If intact, patients were immobilized in long-arm casts and plain anteroposterior and lateral radiographs were made after 1 week. If disrupted, closed reduction and percutaneous pinning and plain anteroposterior and lateral radiographs were made for 2-3 weeks. For immobilization in long-arm casts and surgical refusal, plain anteroposterior and lateral radiographs were made for 5-7 days.Results Cartilage hinges were intact （n=11） and disrupted （n=24）. And 8/24 disrupted children rejected surgery and were immobilized in long-arm casts. Two of them became displaced after 1 week and there were 3 displacements after 2-3 weeks. For 11 intact and 16 operated children, there was no displacement.Conclusions Ultrasonic examination is simple, convenient, accurate and sedation-free for managing lateral humeral condyle fractures in children. It should be routinely applied for early stability evaluations of minimally displaced or nondisplaced lateral humeral condyle fractures in children.