【摘要】：目的:肱骨外髁骨折是5～12歲兒童肘部最常見(jiàn)的損傷,在兒童骨折中發(fā)病率僅次于肱骨髁上骨折,占肱骨遠(yuǎn)端骨折的16.9%。在Jakob Ⅰ型肱骨外髁骨折治療方案中,存在很大的爭(zhēng)議。而且該類(lèi)骨折在保守治療中非常容易發(fā)生再移位,一旦骨折發(fā)生移位,不及時(shí)予以手術(shù)治療,極易形成骨折不愈合,進(jìn)而成為陳舊性肱骨外髁骨折,易促使骨不連、肘內(nèi)翻、肘外翻、魚(yú)尾狀畸形、尺神經(jīng)炎等并發(fā)癥的發(fā)生,且在后期治療上成為比較棘手的難題。而該文研究?jī)和疛akob Ⅰ型肱骨外髁骨折通過(guò)影像學(xué)磁共振技術(shù)(MRI)檢查肱骨遠(yuǎn)端軟骨鉸鏈?zhǔn)欠裢暾?從而判定此類(lèi)骨折的穩(wěn)定性,并且根據(jù)MRI檢查結(jié)果對(duì)肱骨外髁骨折的治療方案選擇進(jìn)行指導(dǎo),提供理論依據(jù)。方法:選取2015年10月～2016年9月于本院就診及有完整資料的Jakob Ⅰ型肱骨外髁骨折病例39例。在臨床治療中,39例患兒,初診時(shí)結(jié)合肘關(guān)節(jié)正側(cè)位X線片及患兒病史體檢,均明確診斷肱骨外髁骨折,且通過(guò)X線片測(cè)量骨折線2 mm。所有患兒均接受肘關(guān)節(jié)MRI影像學(xué)檢查。MRI檢查結(jié)果回歸后依據(jù)MRI結(jié)果分為A、B兩組,記錄根據(jù)MRI影像學(xué)結(jié)果將其分為兩型:Jakob Ⅰ A型骨折:骨折線從干骺端至生長(zhǎng)板,未穿過(guò)生長(zhǎng)板,軟骨鉸鏈存在;Jakob ⅠB型骨折(B組):骨折線穿過(guò)生長(zhǎng)板,延伸至關(guān)節(jié)面,軟骨鉸鏈不存在。治療初期,兩組患兒均予前臂全長(zhǎng)石膏托固定非手術(shù)治療。定期復(fù)診,X線平片檢查(第一次3～5d,以后每7d檢查)。根據(jù)復(fù)診時(shí)X線平片結(jié)果,提示無(wú)再移位(骨折線2 mm)的肱骨外髁骨折繼續(xù)石膏固定,并在復(fù)查時(shí)加固石膏托;而提示移位明顯加重(骨折線 2 mm)的患兒給予手術(shù)治療。后期依據(jù)Dhillon評(píng)分,比較所有患兒骨折愈合及肘關(guān)節(jié)功能。結(jié)果:A組有33例無(wú)再移位,1例再移位明顯加重并行手術(shù)治療;B組有2例無(wú)再移位,3例再移位明顯加重并行手術(shù)治療。Jakob Ⅰ A型骨折再移位率為2.9%,Jakob ⅠB型骨折再移位率為60%,與Jakob Ⅰ A型骨折相比較,Jakob ⅠB型骨折經(jīng)非手術(shù)治療,再移位發(fā)生率明顯增加(P0.01)。兩型骨折預(yù)后優(yōu)良率100%,但Jakob Ⅰ A型病例預(yù)后評(píng)分為優(yōu)者有28例,占優(yōu)率82.36%,Jakob Ⅰ B型病例預(yù)后評(píng)分為優(yōu)者有2例,占優(yōu)率40.00%,B型骨折預(yù)后評(píng)分占有率明顯降低(P0.05)。結(jié)論:針對(duì)Jakob Ⅰ型肱骨外髁骨折的穩(wěn)定性和治療方案,僅依靠X線平片的結(jié)果是遠(yuǎn)遠(yuǎn)不夠的,MRI更易顯示出兒童Jakob Ⅰ型肱骨外髁骨折的穩(wěn)定性,MRI中顯示肱骨遠(yuǎn)端軟骨鉸鏈不存在的Jakob Ⅰ B型骨折更容易發(fā)生再移位風(fēng)險(xiǎn),且Jakob Ⅰ B型骨折預(yù)后較Jakob Ⅰ A型差,臨床上應(yīng)該積極予以手術(shù)治療,以此來(lái)減少后期肘關(guān)節(jié)功能障礙及相關(guān)并發(fā)癥的發(fā)生。這也為臨床治療兒童Jakob Ⅰ型肱骨外髁骨折提供理論依據(jù)。
[Abstract]:Objective: the fracture of lateral condyle of humerus is the most common injury of elbow in children aged 512 years. The incidence of fracture is second only to supracondylar fracture of humerus, accounting for 16.9 times of fracture of distal humerus. There is great controversy in the treatment of Jakob type I lateral condylar fracture of humerus. Moreover, this kind of fracture is very easy to be redisplaced in conservative treatment. Once the fracture is displaced, if the fracture is not treated in time, it is easy to form the fracture nonunion, and then become the old fracture of the lateral condyle of the humerus, which is apt to promote nonunion and cubitus varus. Cubitus valgus, fishtail deformity, ulnar neuritis and other complications, and later treatment has become a difficult problem. In order to determine the stability of Jakob type I fracture of the lateral condyle of humerus, we examined the integrity of cartilage hinge of distal humerus by magnetic resonance imaging (MRI) in children. According to the results of MRI, the treatment scheme of humeral lateral condylar fracture was guided and the theoretical basis was provided. Methods: 39 cases of Jakob type 鈪，

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