儿童外伤性肘关节脱位的诊治

Diagnoses and treatments of traumatic elbow dislocation in children

目的探讨外伤性肘关节脱位患儿的临床特点和诊治策略。方法收集2015年1月至2022年1月福建泉州市正骨医院收治的肘关节脱位患儿53例的临床资料,其中男42例,女11例;平均年龄为10.2岁(1~15岁)。分析脱位的临床特点、诊断检查方法、治疗方法,运用Mayo肘关节功能评分进行临床疗效的评定并随访。结果53例患儿中,左侧21例,右侧32例;单纯肘关节脱位占5.7%(3/53),合并单一骨折或韧带损伤占62.3%(33/53),合并多发骨折或韧带损伤占32%(17/53)。合并神经损伤:尺神经损伤3例,桡神经损伤3例;所有病例均使用了X线检查,其中只采用X线检查占47.2%(25/53),采用X线及CT检查占28.3%(15/53),采用X线及MRI检查占7.4%(4/53),采用X线及肌骨超声检查占5.7%(3/53),采用X线、肌骨超声及MRI检查占5.7%(3/53),采用X线、CT及MRI检查占1.9%(1/53),采用X线、CT及肌骨超声检查占1.9%(1/53),采用X线、CT、MRI及肌骨超声检查占1.9%(1/53)。闭合复位石膏固定14例,切开复位内固定39例。所有病例均获得随访,随访时间为6.2(3~24)个月,愈合时间为7.2(6~8)周。末次随访时依据Mayo肘关节功能评分标准的评定结果是:优46例,良6例,可1例,差0例。所有患儿均无切口感染、再脱位的并发症出现。结论外伤性肘关节脱位多数合并有肘部骨折,早期识别并及时治疗可以获得骨性愈合和良好的肘关节功能。

Objective To explore the clinical characteristics and management strategies of traumatic elbow dislocation in children.Methods From January 2015 to January 2022,the relevant clinical data were retrospectively reviewed for 53 children with elbow dislocation.There were 42 boys and 11 girls with an average age of 10.2(1-15)years.Clinical characteristics,diagnostic modalities and treatment modes were recorded.Mayo elbow function score was utilized for evaluating the clinical efficacies and outcomes.Results Involved side was left(n=21)and right(n=32).Simple elbow dislocation accounted for 5.7%(3/53),concurrent single fracture or ligament injury 62.3%(33/53)and concurrent multiple fractures or ligament injury 32%(17/53).There were concurrent ulnar nerve injury(n=3)and concurrent radial nerve injury(n=3).Radiograph alone accounted for 47.2%(25/53),radiograph plus computed tomography(CT)28.3%(15/53),radiograph plus magnetic resonance imaging(MRI)7.4%(4/53),radiograph plus musculoskeletal ultrasonography 5.7%(3/53),radiograph,musculoskeletal ultrasonography plus MRI 5.7%(3/53),radiograph,CT plus MRI 1.9%(1/53),radiograph,CT plus musculoskeletal ultrasonography 1.9%(1/53)and radiograph,CT,MRI plus musculoskeletal ultrasonography 1.9%(1/53).Treatments included closed reduction plus plaster fixation(n=14)and open reduction plus internal fixation(n=39).The follow-up period was 6.2(3-24)months and healing time 7.2(6-8)weeks.According to the Mayo elbow function score,the outcomes were excellent(n=46),good(n=6)and fair(n=1)at the last follow-up,There was no instance of incision infection or redislocation.Conclusion Most cases of traumatic elbow dislocation are associated with elbow fracture.Early identification and timely treatment can achieve bone healing and restore elbow function.