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目的探讨通过影像学磁共振技术(MRI)判定JacobⅠ型肱骨外髁骨折患儿骨折的稳定性,并指导其治疗方案的选择。方法选取2015年10月至2016年9月于本院就诊且资料完整的JacobⅠ型肱骨外髁骨折病例39例。根据MRI检查结果将其分为两组:A组——骨折线从干骺端至生长板,未穿过生长板,关节面完整,软骨铰链存在;B组——骨折线穿过生长板,延伸至关节面,软骨铰链不存在。A、B两组骨折均先予石膏固定,定期随访;对随访中无再移位病例继续予以石膏固定;对随访中移位明显加重者予手术治疗。治疗后期依据Dhillon评分,比较所有患儿骨折愈合及肘关节功能情况。结果 A组有33例无再移位,1例再移位明显加重者予手术治疗;B组有2例无再移位,3例再移位明显加重者予手术治疗。A组骨折再移位率为2.9%,B组骨折再移位率为60%,与A组比较,B组骨折经非手术治疗后再移位的发生率明显增加(χ~2=15.42,P=0.004 9),且B组骨折预后评分占优率明显降低(χ~2=1.125,P=0.013)。结论关于JacobⅠ型肱骨外髁骨折的稳定性与治疗方案,仅依靠X线平片检查结果是不够的,MRI更容易显示儿童JacobⅠ型肱骨外髁骨折的稳定性,这为临床治疗儿童JacobⅠ型肱骨外髁骨折提供了理论依据。
Objective To investigate the stability of the fracture of the humeral type I humeral condylar fracture by imaging magnetic resonance imaging (MRI) and to guide its treatment options. Methods A total of 39 cases of Jacob Ⅰ type humeral condylar fracture were selected in our hospital from October 2015 to September 2016. According to the results of MRI examination, they were divided into two groups: Group A - fracture line from the metaphyseal to the growth plate, not through the growth plate, the articular surface integrity, cartilage hinge exist; B group - fracture line through the growth plate, Extends to the articular surface, cartilage hinge does not exist. The fractures in groups A and B were fixed with plaster first and followed up regularly. No follow-up cases were continued with plaster fixation. Those who were displaced significantly during the follow-up were surgically treated. According to the Dhillon score at the later stage of treatment, all children with fracture healing and elbow joint function were compared. Results There were 33 cases in group A without further metastases and 1 case with further significant shift. Surgical treatment was performed in 2 cases with no further shift in group B and in 3 cases with further significant shift. In group A, the rate of re-migration was 2.9% and that of group B was 60%. Compared with group A, the incidence of re-displacement in group B was significantly increased after non-surgical treatment (χ ~ 2 = 15.42, P = 0.004 9), and the prognosis score of group B was significantly lower (χ ~ 2 = 1.125, P = 0.013). Conclusion The stability and treatment of Jacob Ⅰ type humeral condyle fracture is not enough to rely solely on X-ray examination. MRI is more likely to show the stability of JacobⅠ humeral condylar fracture in children, Condylar fractures provide a theoretical basis.