肘关节造影在6岁以下儿童严重桡骨颈骨折治疗中的应用

Application of elbow arthrography in the treatment of severe radial neck fractures in children under 6 years old

目的介绍肘关节造影在6岁以下儿童严重桡骨颈骨折的应用价值,并总结其临床疗效。方法自2012年5月至2016年12月我院共收治6岁以下严重桡骨颈骨折患儿18例,男11例,女7例;年龄40~70个月,平均59.7个月。术前摄片均未及明显骨化中心,仅可见干骺端一移位薄骨片。根据O'Brien分型Ⅱ型8例,Ⅲ型10例。麻醉下常规行肘关节外侧穿刺造影,手法复位+Metaizea法;若手法复位不满意者采用经皮钢针撬拨复位+Metaizea法,必要时切开复位。术后长臂石膏固定4周。术后评价参照Tibone和Stoltz评分系统,健侧、患侧X线片评价有无桡骨头缺血坏死,骨骺早闭、关节内钙化及关节融合。结果1例患儿术中出现轻微皮肤过敏,其余患儿未出现造影剂不良反应。肘关节造影可清晰显露关节面及骨折移位程度,所有患儿均通过闭合和/或钢针撬拨复位成功,无需切开复位。X线检查均提示骨折愈合良好,骨折处无畸形愈合,无骨骺早闭及桡骨头缺血坏死。根据Tibone和Stoltz评价标准:优13例,良4例。结论对于6岁以下的儿童严重桡骨颈骨折,术中关节造影能清晰判断骨折的移位程度及评估复位质量,方法简单、有效,临床疗效满意,值得推广。

Objective To introduce the application value of elbow arthrography in severe radial neck fractures in children younger than 6 years old and to summarize its clinical efficacy. Methods From May 2012 to December 2016, 18 children under 6 years old with severe radial neck fractures were treated in our hospital, including 11 males and 7 females, aged 40 to 70 months, with an average of 59.7 months. The preoperative radiographs did not show any obvious ossification center and only a thin bone slice displaced from metaphysis could be seen. According to O'Brien classification, there were 8 cases of type Ⅱ and 10 cases of type Ⅲ. Under anesthesia, routine lateral elbow arthrography and manual reduction with Metaizeau technique were conducted. If manual reduction is unsatisfactory, percutaneous pin prying reduction with Metaizeau technique or open reduction was conducted. After the operation, the long arm plaster was used for fixation for 4 weeks. Postoperative evaluation was based on Tibone and Stotz scoring system. Radial head ischemic necrosis, epiphyseal premature closure, intra-articular calcification and joint fusion were evaluated by X-ray films of the healthy and the injured side. Results One child had minor skin allergy during operation, and the others did not have adverse effects. Elbow arthrography can clearly reveal the articular surface and the degree of fracture displacement. All the patients were successfully repositioned by closed and/or pin prying reduction without open reduction. X-ray examination showed that the fracture healed well. There was no malunion at the fracture site, no premature epiphyseal closure and necrosis of the radius head. According to Tibone and Stotz criteria, 13 cases were excellent and 4 cases were good. Conclusion The intraoperative arthrography can provide a clear judgment of the displacement degree of fracture and evaluation of reduction quality for the patients with severe radial neck fractures under 6 years old. The method is simple and effective, and the clinical effect is satisfactory. It is worth promoting.