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儿童肱骨髁上骨折后桥接性骨化性肌炎:一例报告

Bridging Myositis Ossificans After Supracondylar Humeral Fracture in a Child: A Case Report.

作者信息

Chen Jiayuan, Li Qilin, Liu Tianjing, Jia Guoqiang, Wang Enbo

机构信息

Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.

Department of Pediatric Orthopaedic and Trauma, Qilu Children's Hospital of Shandong University, Jinan, China.

出版信息

Front Pediatr. 2021 Nov 18;9:746133. doi: 10.3389/fped.2021.746133. eCollection 2021.

Abstract

Myositis ossificans is an uncommon complication of trauma and surgery, defined as ossifying changes in a non-osseous tissue such as muscles. It happens after tissue injury, with or without fractures. When myositis ossificans occurs around a joint, it can cause ankylosis, leading to complete dysfunction of the joint. Though it has been described in most parts of the body, bridging myositis ossificans involving the elbow joint were scarcely reported. We report a severe case of myositis ossificans after a supracondylar humerus fracture in a 9-year-old child. In this case a palpable painless mass appeared following the fracture and surgical trauma. Ultrasound or X-ray is of significant diagnostic value. The brachialis was completely ossified and formed a bony bridge around the elbow, causing complete ankylosis. The bone mass was surgically removed through a bilateral less-invasive approach with less surgical trauma 9 months after initial presentation. we applied bone wax to the fresh bone wounds to prevent the formation of hematocele. Indomethacin, a non-steroidal anti-inflammatory drug, was administered after the operation to suppress bone proliferation in our case. Our patient had the best possible functional status and no recurrence at 2 years' follow-up. Elbow myositis ossificans in children may mainly affects the brachialis. A bilateral less-invasive approach is sufficient to remove the bone mass with less surgical trauma. This case also provides a new reference for the treatment of myositis ossificans after the elbow injuries.

摘要

骨化性肌炎是创伤和手术中一种罕见的并发症,定义为非骨性组织(如肌肉)发生骨化改变。它发生在组织损伤后,无论有无骨折。当骨化性肌炎发生在关节周围时,可导致关节强直,引起关节完全功能障碍。尽管在身体的大部分部位都有相关描述,但涉及肘关节的桥接性骨化性肌炎报道较少。我们报告一例9岁儿童肱骨髁上骨折后发生的严重骨化性肌炎病例。在此病例中,骨折及手术创伤后出现一个可触及的无痛性肿块。超声或X线具有重要的诊断价值。肱肌完全骨化,在肘关节周围形成骨桥,导致完全性关节强直。初次就诊9个月后,通过双侧微创入路手术切除骨块,手术创伤较小。我们在新鲜骨创面涂抹骨蜡以防止血肿形成。在我们的病例中,术后给予非甾体类抗炎药吲哚美辛以抑制骨增生。我们的患者在2年随访时功能状态最佳且无复发。儿童肘关节骨化性肌炎可能主要影响肱肌。双侧微创入路足以切除骨块且手术创伤较小。该病例也为肘部损伤后骨化性肌炎的治疗提供了新的参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ed7/8636899/a5b0eacb2d5c/fped-09-746133-g0001.jpg

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