MRI对儿童Jakob Ⅰ型肱骨外髁骨折治疗的应用研究

发布时间：2018-10-05 21:24

【摘要】：目的:肱骨外髁骨折是5～12岁儿童肘部最常见的损伤,在儿童骨折中发病率仅次于肱骨髁上骨折,占肱骨远端骨折的16.9%。在Jakob Ⅰ型肱骨外髁骨折治疗方案中,存在很大的争议。而且该类骨折在保守治疗中非常容易发生再移位,一旦骨折发生移位,不及时予以手术治疗,极易形成骨折不愈合,进而成为陈旧性肱骨外髁骨折,易促使骨不连、肘内翻、肘外翻、鱼尾状畸形、尺神经炎等并发症的发生,且在后期治疗上成为比较棘手的难题。而该文研究儿童Jakob Ⅰ型肱骨外髁骨折通过影像学磁共振技术(MRI)检查肱骨远端软骨铰链是否完整,从而判定此类骨折的稳定性,并且根据MRI检查结果对肱骨外髁骨折的治疗方案选择进行指导,提供理论依据。方法:选取2015年10月～2016年9月于本院就诊及有完整资料的Jakob Ⅰ型肱骨外髁骨折病例39例。在临床治疗中,39例患儿,初诊时结合肘关节正侧位X线片及患儿病史体检,均明确诊断肱骨外髁骨折,且通过X线片测量骨折线2 mm。所有患儿均接受肘关节MRI影像学检查。MRI检查结果回归后依据MRI结果分为A、B两组,记录根据MRI影像学结果将其分为两型:Jakob Ⅰ A型骨折:骨折线从干骺端至生长板,未穿过生长板,软骨铰链存在;Jakob ⅠB型骨折(B组):骨折线穿过生长板,延伸至关节面,软骨铰链不存在。治疗初期,两组患儿均予前臂全长石膏托固定非手术治疗。定期复诊,X线平片检查(第一次3～5d,以后每7d检查)。根据复诊时X线平片结果,提示无再移位(骨折线2 mm)的肱骨外髁骨折继续石膏固定,并在复查时加固石膏托;而提示移位明显加重(骨折线 2 mm)的患儿给予手术治疗。后期依据Dhillon评分,比较所有患儿骨折愈合及肘关节功能。结果:A组有33例无再移位,1例再移位明显加重并行手术治疗;B组有2例无再移位,3例再移位明显加重并行手术治疗。Jakob Ⅰ A型骨折再移位率为2.9%,Jakob ⅠB型骨折再移位率为60%,与Jakob Ⅰ A型骨折相比较,Jakob ⅠB型骨折经非手术治疗,再移位发生率明显增加(P0.01)。两型骨折预后优良率100%,但Jakob Ⅰ A型病例预后评分为优者有28例,占优率82.36%,Jakob Ⅰ B型病例预后评分为优者有2例,占优率40.00%,B型骨折预后评分占有率明显降低(P0.05)。结论:针对Jakob Ⅰ型肱骨外髁骨折的稳定性和治疗方案,仅依靠X线平片的结果是远远不够的,MRI更易显示出儿童Jakob Ⅰ型肱骨外髁骨折的稳定性,MRI中显示肱骨远端软骨铰链不存在的Jakob Ⅰ B型骨折更容易发生再移位风险,且Jakob Ⅰ B型骨折预后较Jakob Ⅰ A型差,临床上应该积极予以手术治疗,以此来减少后期肘关节功能障碍及相关并发症的发生。这也为临床治疗儿童Jakob Ⅰ型肱骨外髁骨折提供理论依据。
[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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