儿童肘关节创伤后骨化性肌炎临床治疗策略分析

An analysis of the clinical treatment strategy of myositis ossificans after elbow trauma in Children

目的探讨患儿肘关节创伤后骨化性肌炎的临床特征、预防措施、治疗及预后。方法回顾性分析 2013 年3月至2019年10月本院诊治的8例肘关节周围创伤后骨化性肌炎患儿的临床资料,所有患儿均未使用药物治疗,4 例早期给予外固定后4~6周循序进行功能锻炼,另有 4 例则早期未给予外固定且行被动活动。随访观察疗效及预后情况。结果早期给予外固定患儿在术后1~2周内出现骨化性肌炎,早期未给予外固定患儿在 4 周内未见骨化性肌炎发生,强行功能锻炼后3~4周内出现骨化性肌炎。早期给予外固定后的患儿骨化性肌炎吸收时间为5~9个月,早期未给予外固定的患儿骨化性肌炎吸收时间为 11~13 个月。出现骨化性肌炎后早期固定的患儿病变局限、成熟更早、吸收时间更短,而继续强行锻炼的患儿病变持续扩大。结论骨化性肌炎多有反复整复及骨折后过度暴力功能锻炼史。粗暴的手术操作及强行被动功能锻炼是儿童肘关节骨化性肌炎发生的主要原因。早期制动是有效的,对于非手术治疗失败的可行手术切除。

Objective To explore clinical characteristics,preventive measures,treatment and prognosis of myositis ossificans after elbow trauma in children.Methods From March 2013 to October 2019,clinical data of 8 children with myositis ossificans after elbow trauma were analyzed retrospectively.No drugs were applied in all cases.Four cases underwent external fixation for 4-6 weeks in early stage and functional exercise in sequence,while four cases not.Treatment results and prognosis were observed.Results Myositis ossificans occurred in patients with external fixation within 2 weeks after operation;no myositis ossificans occurred within 4 weeks in patients with conservative treatment,but it occurred within 3-4 weeks after forced functional exercise.The absorption time of ossifying myositis was 5-9 months after early external fixation,and 11-13 months for those without external fixation.Limited lesion,earlier maturity and shorter absorption were observed in cases with early fixation,however,lesions continued to expand in cases without early fixation.Conclusions Repeated reduction and excessive violent functional exercise after fracture attribute to myositis ossificans in children.Early immobilization is effective,and surgery is recommended after failed conservative treatment.