结合关节造影、单人闭合复位治疗儿童肱骨远端全骨骺分离骨折的疗效观察

目的探讨关节造影下单人闭合复位治疗儿童肱骨远端全骨骺分离骨折的手术技巧及疗效。 方法回顾性分析2017年1月至2020年1月期间中山市中医院收治的43例肱骨远端全骨骺分离骨折患儿的临床病历资料，其中男32例、女11例；年龄1.5 ~ 4.2个月，平均2.8个月。伸直尺偏型37例，伸直桡偏型6例；高处坠落伤18例，运动中摔伤25例。受伤至手术时间为12 ~ 34 h，平均20.5 h。均可采用关节造影、单人操作完成闭合复位，助手经皮克氏针内固定术，术后石膏托外固定。术后3、6、9个月时采用Flynn肘关节临床功能评分标准评定疗效。 结果本组手术时间（32.8±10.6）min，术中透视次数（10.5±3.2）次。平均住院时间4 d（3 ~ 7 d）。43例均获得随访，平均随访时间18.4个月（9 ~ 36个月）。术后3 ~ 4周，X线片显示骨折临床愈合后，拆除石膏并拔除克氏针。按照Flynn肘关节临床功能评分标准评定疗效：术后3个月优良率为81.4％（35/43），术后6个月优良率为88.3％（38/43），术后9个月优良率为88.3％（38/43）。术后患儿均未出现骨筋膜室综合征、血管神经损伤、皮肤坏死、钉道感染等并发症。 结论术中肘关节造影可清晰地显示肱骨远端软骨，指导单人闭合复位微创治疗肱骨远端全骨骺分离骨折，直观判断复位后效果，指导经皮穿入克氏针，取得满意的治疗效果，本方法操作相对简单，易于掌握，疗效确切，有利于肘关节功能早期恢复，值得推广。

Curative effect observation of arthrography combined with single closed reduction in the treatment of entire distal humeral metaphyseal separation fractures in children

BackgroundThe entire distal humeral metaphyseal separation fractures is a special injury of elbow joint in children. Due to the incomplete ossification of distal humerus in this age group, it is hard to clearly show the distal humerus by ordinary X-ray, which brings difficulties to diagnosis and treatment and is also prone to complications. With the development of arthrography technology and minimally invasive treatment of supracondylar fracture of humerus, the treatment as well as the effect has improved, and the related reports are few. ObjectiveTo investigate the surgical technique and efficacy of arthrography combined with single closed reduction in the treatment of entire distal humeral metaphyseal separation fractures in children. MethodsFrom January 2017 to January 2020, the clinical data of 43 children (32 males and 11 females) with entire distal humeral metaphyseal separation fractures were retrospectively analyzed. There were 37 cases of extension-ulnar type and 6 cases of extension-radial type. The ages ranged from 1 year 5 months to 4 years and 2 months, with an average age of 2 years and 8 months. There were 18 cases of high fall damages and 25 cases of sports injuries. The time from injury to operation was 12 to 34 hours, with an average of 20.5 hours. Arthrography combined single closed reduction were applied with Kirschner wire and plaster fixation by the assistant. In the 3rd, 6th, and 9th month after operation, Flynn elbow clinical function score was used to evaluate the curative effect. ResultsThe operation time was (32.8±10.6) min, and the the X-ray frequency was (10.5±3.2) times. The average hospital stay was 4 days (3-7 days) . The average follow-up time was 18.4 months (9-36 months) . The X-ray showed fracture healing 3 to 4 weeks after operation, and then the plaster and Kirschner wire were removed. According to Flynn elbow clinical function score, the excellent and good rates were 81.4% (35/43) in the 3rd month and 88.3% (38/43) in the 6th month postoperatively. No complications such as osteofascial compartment syndrome, vascular and nerve injury, skin necrosis or nail tract infection occurred. ConclusionIntraoperative arthrography of the elbow joint can clearly show the cartilage of distal humerus, and help guide the treatment of entire distal humeral metaphyseal separation fractures with single closed reduction and minimally invasive fixation. It can directly judge the effect of reduction and guide the percutaneous insertion of Kirschner wire, which obtains satisfactory therapeutic effect. This method is relatively simple to operate, easy to grasp, effective, conducive to the early recovery of elbow joint function, and worthy of promotion.