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儿童肱骨髁上无移位骨折后肱骨小头溶解:一例短暂性骨软骨病病例报告

Dissolution of the capitellum after nondisplaced supracondylar fracture of the humerus in a child: a case report of transient osteochondrosis.

作者信息

Ruiz Picazo D, Ramírez Villaescusa J, Delgado García A B

机构信息

Departments of aOrthopaedic Surgery bPaediatrics, Complejo Hospitalario Universitario De Albacete, Albacete, Spain.

出版信息

J Pediatr Orthop B. 2015 May;24(3):219-22. doi: 10.1097/BPB.0000000000000161.

Abstract

Supracondylar fractures of the humerus are the most common type of elbow fractures in children. Nonunion of the lateral condyle, cubitus varus, cubitus valgus, fishtail deformity, or growth disorders, including premature physeal arrest or even avascular necrosis, are uncommon but important complications. However, transient osteochondrosis of the capitellum after a supracondylar fracture has been reported in only two cases in the literature. We report our experience of transient osteochondrosis of the capitellum in a 5-year-old boy after conservative treatment with cast immobilization for a nondisplaced supracondylar fracture of the distal humerus with 8 years of follow-up. Serial radiography of both the injured and the contralateral elbows were performed, which enabled monitoring of the evolution of the transient osteochondrosis. No specific treatment was provided because there was no evidence of acute complication or of a progressing deformity. The patient had gained full range of motion of the elbow without pain by 6 weeks of follow-up. At 5 years after the fracture, the ossification center of the capitellum was restored to its normal size and shape. There was no evidence of growth disturbances in this case. This case report is an uncommon case of transient osteochondrosis of the capitellum in the distal humerus after conservative treatment for nondisplaced supracondylar fractures in children. The evolution of this entity is good and it is managed by conservative treatment.

摘要

肱骨髁上骨折是儿童肘部骨折最常见的类型。外侧髁不愈合、肘内翻、肘外翻、鱼尾状畸形或生长障碍,包括骨骺过早停止生长甚至缺血性坏死,虽不常见但却是重要的并发症。然而,文献中仅报道过两例肱骨髁上骨折后出现的肱骨头暂时软骨病。我们报告了一名5岁男孩肱骨远端无移位髁上骨折经石膏固定保守治疗后出现肱骨头暂时软骨病的病例,并进行了8年的随访。对受伤侧和对侧肘部进行了系列X线检查,以监测肱骨头暂时软骨病的发展情况。由于没有急性并发症或畸形进展的证据,未给予特殊治疗。随访6周时,患者肘部已获得完全活动范围且无疼痛。骨折后5年,肱骨头的骨化中心恢复到正常大小和形状。该病例未出现生长紊乱的迹象。本病例报告是儿童肱骨远端无移位髁上骨折保守治疗后出现肱骨头暂时软骨病的罕见病例。该病症发展良好,采用保守治疗即可。

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