正常儿童肘关节X线侧位片上肱骨前线与肱骨小头位置关系研究

Study of Position Relationship of Anterior Humeral Line with Capitulum Humeri of Normal Elbow Joints in Children Showed by X-ray Lateral Radiography

【目的】探讨肱骨前线(AHL)与肱骨小头在正常儿童肘关节中的位置关系和可能的影响因素,为中医临床骨科医师应用肱骨前线判断儿童肘关节损伤、评估肱骨髁上骨折复位及分析其预后等方面提供理论依据。【方法】回顾性分析997例正常儿童肘关节的X线侧位片,测算AHL与肱骨小头的位置关系,并对可能的影响因素如年龄、性别、方位进行比较。【结果】(1)排除未出现肱骨小头骨化核12例,肱骨小头骨化核与其他骨骺融合13例,看不清影像信息12例,既往风湿病史2例,最后共收集到有效资料958例。(2)骨科医生所测结果与非骨科医生所测结果比较,差异有统计学意义(P=0.001<0.05);而Kappa=0.44>0.4,说明两者测量结果一致性尚可。(3)82%的AHL经过肱骨小头中间1/3区域,其位置关系与年龄有关(P<0.05),与性别和方位无关(P>0.05)。【结论】在大多数正常儿童的生理结构中,AHL穿过肱骨小头的中间1/3区域,而年龄越小,差异越大。

Objective To investigate the position relationship of anterior humeral line（AHL）with capitulum humeri of normal elbow joints in children and the possible influence factors,thus to provide the theoretical basis for judging the injury of elbow joints in children, evaluating the reduction of supracondylar fracture of the humerus,and analyzing the prognosis by AHL for clinical orthopedists of traditional Chinese medicine. Methods The X-ray lateral radiographic results for normal elbow joints in a total of 997 cases of children were analyzed retrospectively. We measured the position of AHL to capitulum humeri,and explored the possible influence factors including age,sex and direction. Results（1）Excluding 12 cases with no ossification of nuclear,13 cases with the fusion of ossification of nuclear with other osteoepiphysis, 12 cases with fuzzy image, and 2 cases with rheumatism history, effective data of 958 cases were collected eventually.（2）The differences of the results measured by the orthopedists and the non-orthopedists were statistically significant（P = 0.0010.05）, and Kappa=0.440.4,indicating that the consistency of the results in the above two groups was well.（3）Eighty-two percent of AHL passed through the middle 1/3 of capitulum humeri,and the position of AHL was correlated with age（P〈0.05）, but was not correlated with the gender and direction（P〉0.05）. Conclusion In physiological structure of a majority of children,the AHL passes through the middle 1/3 of the capitullum,and the variability of AHL is greater in the children with less years old.