关节造影辅助治疗儿童骨折移位≤2mm肱骨外髁骨折

Arthrography in treatment of humeral condyle fractures with displacement of less than 2 mm in children

目的评价关节造影辅助治疗儿童骨折移位≤2mm肱骨外髁骨折的临床疗效。方法回顾性分析2015年4月至2016年12月西安交通大学医学院附属红会医院小儿骨科收治的21例肱骨外髁骨折患儿资料。男14例，女7例；年龄5—12岁，平均8．6岁；初诊时间均在受伤1周内，骨折移位≤2mm。所有患儿均在术中使用关节造影，其中2例患儿术中关节造影发现关节软骨未断裂，行石膏固定（A组），11例患儿发现关节软骨断裂、关节间隙围受累及，单纯行闭合穿针（B组），8例患儿发现软骨关节面受累及，行切开复位克氏针固定（C组）。末次随访时根据Dhillon评分评定疗效。结果21例患儿术后均获随访，随访时间为9。23个月，平均16个月。A组和B组患儿骨折愈合时间为8—10周，平均9周。C组患儿骨折愈合时间为11．13周，平均12周。末次随访时根据Dhillon肘关节功能评分评定疗效：A组2例患儿优1例，良1例；B组优8例，良2例，一般1例；C组优6例，良1例，一般1例。A、B组均未见骨骺早闭、骨坏死及鱼尾状畸形等并发症。C组患儿1例肘关节屈伸活动部分受限，1例出现鱼尾状畸形，1例出现股骨头坏死。3组患儿均无感染和皮肤坏死等并发症发生。结论术中关节造影可明确评判关节面是否平整或发现移位不稳定因素，弥补X线片对关节面完整性判断不足问题，结合早期经皮或切开穿针固定手术，可增加治疗成功率，有效降低骨折再移位并发症发生率。

Objective To evaluate the clinical efficacy of arthrography in the treatment of lateral condylar fracture of humerus with displacement of ≤ 2 mm in children. Methods A retrospective study was performed in the 21 children with lateral condylar fracture of humerus who had received arthrography in their surgery at Department of Pediatric Orthopedics, Honghui Hospital, Xi＇an Jiaotong University College of Medicine from April 2015 to December 2016. They were 14 boys and 7 girls, aged from 5 to 12 years （average, 8.6 years）. Their primary diagnosis was made within one week from injury and they all had a displacement of ≤ 2 mm. Of them, 2 were treated by piaster fixation because intraoperatlve arthrography found no fracture of articular cartilage （group A）, 11 by simple closed pining because intraoperative arthrography found fracture of articular cartilage involving the joint space （group B）, and 8 by open reduction and fixation with kirschner wire because intraoperative arthrography found displacement of the involved articular surface （group C）. The therapeutic ef- ficacy was evaluated at final follow-ups by the Dhiflon scoring system. Results All the 21 children were followed up from 9 to 23 months （average, 16 months） . The fracture union time ranged from 8 to 10 weeks （average, 9 weeks） for groups A and B and from 11 to 13 weeks （average, 12 weeks） for group C. By the Dhillon scores at final follow-ups, the therapeutic efficacy was evaluated as excellent in one and as good in one in group A, as excellent in 8 cases, as good in 2 cases and as fair in one in group B, and as excellent in 6 cases, as good in one and as fair in one in group C. No early closure of epiphysis, osteonecrosis or fishtail deformity was found in either group A or group B; one case of partial limitation of elbow flexion or extension, one case of fishtail deformity and one case of femoral head necrosis were observed in group C. No infection or skin necrosis was found in any of the 3 groups. Conclusions Because intraoperative arthrography can definitely judge whether the articular surface is intact or unstable, it can make up for the insufficiency of X-rays in judging integrity of the articular surface. In combination with closed reduction, percutaneous puncture or open reduction and internal fixation, intraoperative arthrography can contribute to an increased rate of successful surgery, and reduced complications due to redisplacement.