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目的评价肱骨远端骨骺分离对婴幼儿肘关节功能及发育的影响。方法回顾性分析从2005年1月至2015年2月,我科确诊收治并随访的16例(16肘)肱骨远端骨骺分离的患儿。所有患儿骨折均为高处跌落致伤,平均受伤年龄18(11~37)个月;男10例,女6例;左肘9例,右肘7例;Salter-Harris I型3肘,Salter-Harris II型13肘;14肘患儿骨折移位方向为后内侧,2肘后外侧移位;6肘受伤时肱骨小头次级骨化中心未出现;5肘行切开复位内固定,11肘行闭合复位内固定,其中1肘术中应用关节造影辅助闭合复位。最后随访时摄双肘关节正侧位X线片及双肱骨正位X线片,测量肱骨尺骨角,肱骨远端前倾角及双肱骨全长,并采用梅奥肘关节功能评分(mayo elbow performance score,MEPS)对所有患儿双肘进行评价,采用独立与配对样本t检验和χ2检验对肘关节形态发育及功能进行统计分析。结果 16例平均随访42.3(6~98)个月,最后随访时肘关节伸直角度患侧平均为5.9°(-10°~22°),健侧7.5°(3°~15°),P=0.33;屈曲角度患侧平均为124.4°(74°~135°),健侧133.1°(123°~145°),P=0.01;影像学指标肱骨远端前倾角患侧平均为47.1°(25°~59°),健侧51.9°(35°~65°),P=0.073;肱骨尺骨角平均为1.2°(-18°~14°),健侧8.8°(2°~19°),P=0.001;肱骨全长患侧平均为20.7(16.0~26.3)cm,健侧20.3(15.5~25.8)cm,P<0.001;MEPS患侧平均为85.6(70~95)分,健侧95(90~100)分,P<0.001。肱骨尺骨角分别与骨折复位方式和Salter-Harris分型差异无统计学意义(P=0.57,0.23);术后MEPS与移位方向、Salter-Harris分型以及复位方式和肱骨小头次级骨化中心,差异无统计学意义(P=1.00,0.35,1.00,0.93)。结论闭合或切开复位内固定治疗婴幼儿肱骨远端骨骺分离,可获得优良的肘关节功能,但肘内翻畸形为最常见的并发症,术中关节造影下辅助骨折复位,可能有利于减少这一并发症的发生。
Objective To evaluate the effect of distal humerus epiphyseal separation on the function and development of elbow in infants. Methods From January 2005 to February 2015, 16 children (16 elbow) with distal epiphyseal humerus who were diagnosed and followed up were retrospectively analyzed. All fractures in children were caused by fall and injury. The average age of injury was 18 (11-37) months. There were 10 males and 6 females, 9 left elbows and 7 right elbows, Salter-Harris type I 3 elbows, Salter-Harris II type 13 elbow; 14 elbow fracture in the direction of displacement of the medial, 2 lateral displacement after the elbow; 6 elbow injury humeral head secondary ossification center did not appear; 5 elbow line open reduction and internal fixation , 11 elbow closed reduction and internal fixation, including 1 elbow arthroplasty assisted closed reduction. At the last follow-up, the elbow joint lateral radiographs and double humeral anteroposterior radiographs were taken and the humerus ulna, the anterior humerus and the double humerus were measured. The Mayo elbow performance score score, MEPS). All elbows were evaluated for elbow flexion, and independent and paired samples t-test and χ2 test were used to analyze the elbow joint morphology and function. Results Sixteen patients were followed up for an average of 42.3 months (range, 6 to 98) months. At the final follow-up, the average elbow flexion angle was 5.9 ° (-10 ° ~ 22 °) and the healthy side was 7.5 ° (3 ° ~15 °) = 0.33; the average ipsilateral flexion angle was 124.4 ° (74 ° ~135 °) and the contralateral angle was 133.1 ° (123 ° ~ 145 °), P = 0.01; 25 ° ~ 59 °), the contralateral side was 51.9 ° (35 ° ~ 65 °), P = 0.073; the average humerus angle was 1.2 ° (-18 ° ~ 14 °) and the healthy side was 8.8 ° (2 ° ~ 19 °) , P = 0.001). The average length of the humerus was 20.7 (16.0-26.3) cm on the affected side and 20.3 (15.5-25.8) cm on the contralateral side, with an average of 85.6 (70-95) on the affected side of the MEPS and 95 (90 ~ 100) points, P <0.001. There was no significant difference between the ulnar humerus and fracture reduction and Salter-Harris classification (P = 0.57,0.23). The postoperative MEPS and shift direction, Salter-Harris classification, and the mode of reduction and humeral head secondary bone Center, the difference was not statistically significant (P = 1.00,0.35,1.00,0.93). Conclusion Closed or open reduction and internal fixation for the treatment of infantile distal humerus epiphyseal separation can obtain excellent elbow function, but cubitus varus deformity is the most common complication, intraoperative arthroscopic assisted fracture reduction may be helpful to reduce The occurrence of this complication.