儿童肱骨远端骨骺分离的临床诊治研究

目的分析儿童肱骨远端骨骺分离（Salter-Harris骨骺损伤）的诊断、治疗经验，以减少误诊和并发症，提高临床诊治水平。方法对2002年1月至2008年1月本院收治的76例确诊为儿童肱骨远端骨骺分离患儿的临床资料进行回顾性分析。对肱骨远端骨骺分离的诊断主要依据患儿临床表现和X射线摄片，治疗采取手法闭合复位、石膏外固定和手术治疗。本研究数据采用秩和检验。结果本组76例肱骨远端骨骺分离患儿中，52例经X射线摄片确诊，24例经手术确诊（均行X射线摄片）。患儿一般情况良好，局部体征主要是肘关节肿胀、疼痛及活动受限。本组患儿全为闭合性骨折，治疗后，除3例有第4、第5指麻木、手指屈曲及活动障碍等尺神经受压表现外，其余患儿患侧前臂、手部皮肤感觉均无异常，腕、掌、指关节活动正常，末稍循环良好。结论肱骨远端骨骺分离主要表现为Salter-HarrisⅡ型骨骺骨折，临床易漏诊和误诊为肱骨内、外髁骨折和肘关节脱位等，需通过肘关节解剖学特点和辅助检查等进行鉴别诊断。肱骨远端骨骺分离的手术治疗效果良好。

Management on Fracture-Separation of Distal Humeral Epiphysis in Children

Objective To analyze the diagnosis and treatment of fracture-separation of distal humeral epiphysis （Salter-Harris epiphyseal injury） in neonates or young children for the purpose of decreasing the misdiagnosis and its complications. Methods From January 2002 to January 2008, 76 cases with fracture-separation of distal humeral epiphysis were analyzed retrospectively. The diagnosis was mainly based on clinical presentations and X-radiology. The closed manipulative reduction and operation were used in this study. The research data were checked by the rank-sum test. Results Fracture-separation of distal humeral epiphysis was diagnosed by X-radiology （n= 52）, clinical information and operative findings （n= 24）. The main clinical presentations of fracture-separation of distal humeral epiphysis were arthrocele, pain and limitation of motion. All cases were closed fracture. There were good peripheral circulation and joint motion of forearm or hand without paresthesia of skin, except 3 eases had ulnar nerve compression with finger flexion, anesthesia of the fourth and fifth finger, and motor disorder. Conclusion The main type of fracture-separation of distal humeral epiphysis is metaphyseal fragment （Salter-Harris type Ⅱ） in neonates or young children. It is frequently misdiagnosed as a fracture of the lateral humeral condyle, a dislocation of the elbow or others. The anatomy characteristic of elbow joint and auxiliary examination can be used in differential diagnosis. The surgical treatment has significant curative effect.