儿童肱骨远端全骺分离的误诊原因分析

Causes of misdiagnosis of distal humeral epiphysiolysis

目的 提高对儿童肱骨远端全骺分离的认识 ,减少误诊。方法 回顾性分析了我院1985～ 2 0 0 1年收治的 2 2例误诊患儿的临床资料及随访结果。年龄 9个月～ 7岁 (3.5岁 )。按Delee分类 :A型 5例 ;B型 9例 ;C型 8例。病程 2 4h以内 10例 ,1～ 7d 7例 ,1周以上 5例 ,最长 35d。结果 切开复位内固定治疗 13例。闭合复位 ,外固定治疗 7例 ,尺骨鹰嘴牵引 2例、结果随访 1～ 16年14例外观和功能恢复满意 ,5例有不同程度的肘内翻畸形 (3例已行截骨矫形 ) ,3例肱骨远端明显畸形。关节活动明显受限。结论 此病误诊率较高。仔细分清幼儿及儿童肱骨小头骨化中心和桡骨的关系是正确诊断的关键。

Objective To improve diagnosis and management of the total distal humeral epiphysiolysis and to minimize misdiagnosis. Methods Twenty children with total distal humeral epiphysiolysis were treated and followed up between 1985 and 2001. The age ranged from 9 months to 7 years (mean 3.5 yrs). According to Delee's classification, 5 cases belonged to type A, 9 to type B and 8 to type C. The course was from 24 hours to 35?d. Open reduction was carried out in 13 patients and close reduction with exterior fixation in 7 cases and skeletal traction through ulnar olecronon in 2 cases. Results The patients were followed up from 1 to 16 years. Excellent results were obtained in 14 cases, cubis varus were encountered in 5 cases, and malunion with articular dysfunction in 3 cases. Conclusions Distal humeral epiphysiolysis is easily misdiagnosed. Recognizing the exact positions of the axis of radius and capitulum of humerus are key to the correct diagnosis of this kind of fracture in children.