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目的探讨儿童肱骨内髁骨折的诊断及治疗方法,以期提高儿童肱骨内髁骨折的诊治水平。方法回顾性分析本院2010~2015年手术治疗的9例儿童肱骨内髁骨折患儿的临床资料,其中Kilfoyle-II型3例,Kilfoyle-III型6例,2例合并肘关节脱位。术前详细体格检查了解肘关节的肿胀、压痛及畸形情况,肘后三角的改变情况,本组均行肘关节正侧位X线片及CT检查,1例5岁患儿并行肘关节MRI检查以证实诊断。手术采取切开复位2~3枚克氏针贯穿骨折端固定。术后石膏固定3周后开始肘关节功能锻炼。结果本组术后骨折均愈合良好,无肘关节畸形出现。2例术后肘关节功能活动受限,其中1例为陈旧性骨折。无伤口感染、医源性血管神经损伤、内固定松动、骨坏死、骨化性肌炎等并发症。肘关节按Dhillon评分标准,7例优,1例良,1例可。结论儿童肱骨内髁骨折容易误诊及漏诊,诊断宜体格检查与影像学相结合。小年龄患儿X线片检查时应充分考虑肱骨远端骨骺不显影,必要时行肘关节MRI检查。治疗应早期诊断及复位固定。
Objective To investigate the diagnosis and treatment of children humeral medial condylar fractures in order to improve the diagnosis and treatment of humeral medial condyle fractures in children. Methods The clinical data of 9 children with humeral medial condylar fractures undergoing surgical treatment from 2010 to 2015 in our hospital were analyzed retrospectively. Among them, 3 were Kilfoyle-II type, 6 were Kilfoyle-III type, and 2 were complicated with elbow dislocation. Preoperative detailed physical examination to understand the elbow swelling, tenderness and deformity, the elbow triangle changes, the group of elbow are lateral X-ray and CT examination, a 5-year-old children with elbow MRI examination To confirm the diagnosis. Surgical removal of open 2 to 3 Kirschner wire fixation through the fracture. Postoperative plaster immobilization 3 weeks after the elbow joint functional exercise. Results This group of fractures healed well without elbow joint deformity. Two patients had limited functional activities of the elbow, one of them was an old fracture. No wound infection, iatrogenic nerve injury, internal fixation loose, osteonecrosis, ossifying myositis and other complications. Elbow by Dhillon scoring criteria, 7 cases of excellent, 1 case of good, 1 case can be. Conclusion Children humeral medial condyle fractures easily misdiagnosed and missed diagnosis, physical examination should be combined diagnosis and imaging. Small children with X-ray examination should take full account of the distal humerus epiphyseal not develop, if necessary, elbow MRI examination. Treatment should be early diagnosis and reset fixation.