儿童肱骨内上髁骨折不同手术切口的比较分析

Comparative analysis of different surgical incisions in treating medial epicondyle fracture of the humerus in children

摘要:

目的：探讨采用肘关节纵切口与横切口治疗儿童肱骨内上髁骨折的疗效差异。方法：回顾性分析我院手术治疗新鲜的儿童肱骨内上髁骨折并得到随访的106例患儿的资料，男67例，女39例，年龄7.3～16.2 岁，平均年龄１2.7 岁。61例手术采用肘内侧纵切口和45例采用横切口进行切开复位骨折，并用克氏针、空心钉或可吸收钉、棒固定。术后石膏托固定3～5周后行功能训练，待骨折完全愈合后再取出内固定。结果：获得随访106例，随访时间7～60月，平均随访时间25月。纵切口组手术时间50～70 min，平均（60.00±3.60） min；手术切口6～9 cm，平均（7.5０±0.18） cm。横切口组手术时间20～30 min，平均（23.00±2.66） min；手术切口2.0～2.5 cm，平均（2.2０±０.13） cm。1例术后发生骨不连，105例患儿术后2～3月随访X片显示骨折骨性愈合，无迟发性尺神经损伤表现。2种方法各有1例术后出现桡神经损伤症状，拔针后神经损伤很快恢复，症状消失，无需进行二次手术。肘关节内侧无压痛，外观无明显外翻畸形，外翻应力试验稳定。肘关节功能评分：99例优，6例良，1例中。结论：经肘关节２种切口都可以用于儿童肱骨内上髁骨折的手术治疗，但肘内后横切口具有切口小、创伤小、手术易操作、花时少、愈合后瘢痕小的优点，是一种更好的手术入路。

Abstract:

Objective：To discuss advantages and disadvantages of two different incisions in treating medial epicondyle fracture of the humerus in children. Methods：One hundred and six children with medial epicondyle fractures were surgically treated and reviewed. Sixty-seven cases are male and thirty-nine are female. The mean age of patients at the time of accident was 12.7 years. The medial epicondylar fragment was anatomically reduced and fixed in all cases. Mean follow-up was 25 months. Function outcome was as－sessed using mayo elbow performance score. Results：Sixty-one cases were longitudinal incisions and forty-five cases were transverse incisions. The mean length was （7.5０±0.18） cm or （2.2０±０.13） cm and it took about （60.00±3.60） min or （23.00±2.66） min to finish one operation. The final result was excellent in 99 cases，good in 6 cases and bad in 1 case. Elbows were stable and pain-free and normal or little limited elbow range of motion was reported in 105 cases. Bone union was achieved in 105 cases and ununion in one case. No case of cubitus valgus >10° was observed. Two cases experienced radial nerve injury but recovered without another operation. Conclusion：The two incisions are feasible in the treatment of humerus medial epicondyle fracture. With the advantages of smaller incision，less invasiveness，easier operation and quicker recovery，transverse incision is better than longitudinal incision.