13例手术治疗的青少年肱骨小头骨折的中期和长期功能及影像学结果

Mid-term and Long-term Functional and Radiographic Results of 13 Surgically Treated Adolescent Capitellum Fractures.

作者信息

Onay Tolga, Gümüştaş Seyit A, Baykan Said E, Akgülle Ahmet H, Erol Bülent, Irgit Kaan S

机构信息

Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital.

Department of Orthopaedics and Traumatology, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.

出版信息

J Pediatr Orthop. 2018 Sep;38(8):e424-e428. doi: 10.1097/BPO.0000000000001208.

DOI:10.1097/BPO.0000000000001208

PMID:29917008

Abstract

BACKGROUND

Capitellum fractures are rare in adolescents, and information in literature is still limited. The purpose of this study was to report the mid-term and long-term functional and radiographic results of 13 surgically treated adolescent capitellum fractures in a level I trauma center.

METHODS

This retrospective study included patients aged 10 to 16 years, who underwent surgery for a capitellum fracture and were followed up for at least 12 months. Fractures were classified according to the McKee modification of the Bryan and Morrey classification, and elbow arthritis was classified using the Broberg and Morrey system. Functional outcomes were assessed with the Mayo Elbow Performance Index (MEPI) and the Turkish-language version of the shortened version of the Disabilities of Arm, Shoulder, and Hand (QuickDASH) scale.

RESULTS

The mean time to surgical intervention was 4.5 days (range, 1 to 18 d). The mean flexion-extension range of motion arc was measured as 115 (range, 45 to 150) degrees. The mean restriction for extension and flexion compared with the uninjured side was measured as 10.7 (range, 0 to 45) and 11.5 (range, 0 to 45) degrees, respectively. The mean MEPI was 87.7 points (range, 50 to 100 points) with 9 patients as excellent, 1 good, 1 fair, and 2 poor results. The mean QuickDASH score was 11 (range, 0 to 57). The mean MEPI score was 95.6 and 75 and the mean QuickDASH score was 2.62 and 25.0 for early surgery group (≤3 d) and late surgery group (>3 d), respectively (P=0.073, 0.024). Elbow joint contracture developed in 4 patients. Implant removal and open release of joint contracture was applied to 2 patients. Elbow arthritis of grade 3 was observed in 2 patients and grade 2 in 1 patient.

CONCLUSIONS

Capitellum fractures may be easily missed on conventional radiographs, if not suspected. Delayed diagnosis may lead to a worsening of the functional outcomes. Computerized tomography is helpful in the determination of these fractures. Early diagnosis and a well-performed surgery is essential for successful outcome.

LEVEL OF EVIDENCE

Level IV-case series.

摘要

背景

青少年肱骨小头骨折较为罕见，文献资料仍然有限。本研究的目的是报告在一级创伤中心对13例接受手术治疗的青少年肱骨小头骨折患者进行的中期和长期功能及影像学结果。

方法

这项回顾性研究纳入了年龄在10至16岁之间、因肱骨小头骨折接受手术且随访至少12个月的患者。骨折根据Bryan和Morrey分类法的McKee改良版进行分类，肘关节关节炎采用Broberg和Morrey系统进行分类。功能结果采用梅奥肘关节功能指数（MEPI）和土耳其语版的上肢、肩部和手部功能障碍简化版量表（QuickDASH）进行评估。

结果

手术干预的平均时间为4.5天（范围1至18天）。屈伸活动范围的平均弧度为115°（范围45至150°）。与未受伤侧相比，伸展和屈曲的平均受限程度分别为10.7°（范围0至45°）和11.5°（范围0至45°）。MEPI平均得分为87.7分（范围50至100分），其中9例为优，1例为良，1例为中，2例为差。QuickDASH平均得分为11分（范围0至57分）。早期手术组（≤3天）和晚期手术组（>3天）的MEPI平均得分分别为95.6和75分，QuickDASH平均得分分别为2.62和25.0分（P=0.073，0.024）。4例患者出现肘关节挛缩。2例患者接受了内固定取出和肘关节挛缩切开松解术。2例患者观察到3级肘关节关节炎，1例患者为2级。