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肱骨髁上骨折后肘内翻畸形的特点。

Characteristics of Cubitus Varus Deformity after Lateral Condylar Fracture of the Humerus.

机构信息

Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan.

出版信息

J Hand Surg Asian Pac Vol. 2021 Jun;26(2):218-222. doi: 10.1142/S2424835521500211.

DOI:10.1142/S2424835521500211
PMID:33928862
Abstract

Lateral humeral condylar fractures often heal with some residual elbow deformity. However, details of angulation or tilting angle of the lateral condyle after the fracture have not been evaluated so far. Between 2008 and 2016, we followed up 80 mild fractures of the lateral humeral condyle for more than a year. Thirty fractures were treated by open reduction and internal fixation (ORIF) with Kirschner wires. Fifty cases were treated with a long arm splint for 3 weeks (Fig. 1). The average age of the patients at the time of the injury was 5.5 years. The humerus-elbow-wrist angle (HEWA), Baumann's angle (BA), and tilting angle (TA) were measured on the radiographs. The active range of motion (ROM) was clinically assessed at unaffected and affected sides at the final follow-up. No significant differences were detected between the sides about TA or ROM at the final follow-up. However, HEWA/ BA showed more significant loss of correction. There were significant differences in BA at the affected side between the ORIF and splint groups. Cubitus varus deformity after lateral humeral condylar fracture is not accompanied by a change in TA or ROM, unlike the deformity after supracondylar or distal epiphyseal fracture of the humerus (Fig. 2). Operative treatment to precisely correct and fix the lateral condylar fracture still retained some cubitus varus deformity, although it might lessen or prevent the deformity when compared to conservative treatment with a splint.

摘要

外侧髁肱骨骨折常伴有一定程度的肘部畸形愈合。然而,目前尚未评估骨折后外侧髁的角度或倾斜角的细节。2008 年至 2016 年,我们随访了 80 例外侧髁轻度肱骨骨折,随访时间超过 1 年。30 例采用克氏针切开复位内固定(ORIF)治疗,50 例采用长臂夹板固定 3 周(图 1)。患者受伤时的平均年龄为 5.5 岁。在 X 线片上测量肱骨-肘-腕角(HEWA)、鲍曼角(BA)和倾斜角(TA)。在最终随访时,临床评估未受累侧和受累侧的主动活动范围(ROM)。最终随访时,TA 或 ROM 在受累侧与健侧之间无显著差异。然而,HEWA/BA 显示出更明显的矫正丢失。ORIF 和夹板组在受累侧的 BA 存在显著差异。与肱骨髁上或远端骺端骨折后发生的肘内翻畸形不同,外侧髁肱骨骨折后发生的肘内翻畸形并不伴有 TA 或 ROM 的改变(图 2)。尽管与夹板保守治疗相比,手术治疗可能会减轻或预防畸形,但精确矫正和固定外侧髁骨折的手术治疗仍会保留一些肘内翻畸形。

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