不同Jacob分型的儿童陈旧性肱骨外髁骨折术后功能研究

Postoperative functions of neglected lateral humeral condyle fractures with different Jacob types in children

目的关于陈旧性肱骨外髁骨折（neglected fracture of lateral humeral condyle，NLHC）的术前不同Jacob分型与切开复位内固定术（open reduction and internal fixation，ORIF）术后的临床功能、影像学表现之间的研究尚不多见。方法2008年1月至2014年12月间，我院共收治40例行ORIF治疗的NLHC患儿。受伤至就诊手术时间为32～112 d，平均65 d；根据骨折块是否移位及移位程度（Jacob分型）分为两组：A组（II型）15例、B组（III型）25例。比较分析：两组患儿末次随访影像学Baumann角（Baumann angle，BA）（评价冠状面情况）、髁干角（Shaft-Condylar angle，SCA）（评价矢状面情况）、Hardacre评分等，并观察并发症发生情况。结果全部病例均获随访。X线示术后6～8周骨折愈合，根据Hardacre标准判断疗效，Jacob II、III型骨折优良率分别为93.3%（14/15）、96.0%（24/25），总优良率为95%（38/40）。Jacob III型骨折较Jacob II型术后优秀率（excellent）增高（χ2＝4.57，P＝0.033）；Jacob III型患儿术后矢状面塑形能力（SCA）较II型差（χ2＝4.571，P＝0.033），两者在冠状面（BA）上的塑形能力相当（χ2＝0.67，P＝0.683）。术后无明显肘内翻/外翻、骨延迟愈合、不愈合、肱骨小头坏死（avascular necrosis，AVN）等发生。结论儿童陈旧性肱骨外髁骨折行切开复位内固定术后可以获得满意的疗效，Jacob III型患儿术后矢状面塑形效果较II型差，原因可能在于术后挛缩的伸肌、纤维组织的牵拉导致骨折远端向后方移位，导致髁干角的增大。

ObjectiveTo explore the postoperative clinical functions and radiographic findings of neglected lateral humeral condyle fractures （NLHC） with different Jacob types.MethodsFrom January 2008 to December 2014, a total of 40 NLHC children underwent open reduction and internal fixation （ORIF）. Based upon the Jacob’s classification, they were divided into two groups of typeⅡ（A, n=15） and type III （B, n=25）. The follow-up radiographic outcomes, including Baumann angle and shaft-condylar angle （SCA）, and Hardacre criteria were compared between two groups.ResultsThe range of follow-up period was 12-103 months. The mean bone union time was 6-8 weeks. According to the Hardacre criteria, the overall excellent ＆ good rate was 95%（38/40） and excellent ＆ good rate 93.3%（14/15） for typeⅡand 96.0%（24/25） for typeⅢ fractures. The excellent rates were statistically significantly different between fracture types II ＆ III （χ2=4.57, P=0.033）. Jacob’s type III patients with postoperative sagittal plane shaping ability （SCA） was worse than that of type II （χ2=4.571, P=0.033）. There was no occurrence of cubitus valgus or varus, delayed union, malunion, nonunion or vascular necrosis.ConclusionsORIF may effectively achieve satisfactory outcomes for NLHC in children. Jacob’s type III patients with postoperative sagittal plane shaping ability （SCA） are worse than type II counterparts. Stretching of contractual extensor and fibrous tissues leads to a rear shift of distal humeral fracture with higher SCA.