空心钉克氏针内固定治疗儿童陈旧性肱骨外髁骨折近期疗效观察

摘要

目的：探讨空心钉克氏针内固定手术治疗儿童陈旧性肱骨外髁骨折的临床疗效。方法回顾性分析2009年10月至2012年12月我们收治并获完整随访的的11例肱骨外髁陈旧性骨折患儿临床资料，其中男9例，女2例，年龄2岁1个月至6岁4个月，平均4岁5个月。患儿受伤至手术时间为30～90 d，平均52 d。受伤初期按Milch分型，MilchⅠ型4例，MilchⅡ型7例，肘关节功能有不同程度受限。患儿均切开复位后用1枚空心钉外加2枚交叉克氏针内固定治疗。术后随访观察骨折愈合时间及并发症情况，术后1年采用Dhillon评分值和Baumann角评定疗效。结果所有患儿术后均获12～34个月（平均22．7个月）随访。均在术后6～8周获骨性愈合。术后1年按照Dhillon评分标准，10例为优，1例为良，优良率100％，术前患侧肘关节活动弧度平均为90．5°±27．3°，术后1年时平均为129．1°±11．8°，二者差异有统计学意义（t＝6．527，P＝0．000）。术后1年所有患儿Baumann角均在正常范围（68°～80°），平均74．3°±4．2°。无一例发生术后感染、骨折延迟愈合、畸形愈合、骨不连、肘内外翻、肱骨小头缺血坏死、医源性血管神经损伤等并发症。结论切开复位后采用1枚空心钉外加2枚交叉克氏针内固定治疗儿童陈旧性肱骨外髁骨折可达到复位满意、内固定稳定和良好的近期疗效，并发症少。%Objetive To discuss the short-term effect of cannulated screw with K-wires used as internal fixation in management of pediatric neglected humeral lateral condylar fractures. Methods The clinical data of 1 1 cases with neglected humeral lateral condylar fracture were analyzed retrospectively.from October 2009 to December 2012.There were 9 boys and 2 girls,aged from 2 years and 1month to 6 year and 4 months old (aver-age,4 years and 5 months).The duration of initially trauma to surgery ranged from 30 to 90 days (average,52 days).According to Milch classification,there were 4 cases of type Ⅰ and 7 cases of type Ⅱ.Elbow function was limited to varying degrees.All patients were fixated with one cannulated screw with two crossed K-wires and followed-up postoperatively,fracture healing time and complications were observed,Dhillon score and Baumman angle were used to assess elbow function at one-year follow-up. Results All 1 1 patients were fol-lowed up from 12 to 34 months (average,22.7 months).Fracture healing was achieved 6 to 8 weeks postopera-tively.At one-year follow up,by the Dhillon score,10 patients got 9 points and 1 patient got 8 points,presenting a 100% good to excellent rate;the average pre-operation elbow range of motion was (90.5°±27.3°),im-proved to (129.1°±11.8°)one year postoperatively,with a significant difference.The average Baumman an-gle was(74.3°±4.2°)(ranged from 68°to 80°).No post-operative injection,delayed union,malunion,nonun-ion,cubitus valgus or varus,capitellum necrosis or iatrogenic lesions to vessels and nerves occurred. Conlu-sion Cannulated screw with K-wires internal fixation can lead to satifactory reduction,stable internal fixation and excellent short-term functional outcomes and fewer complications.