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[儿童肱骨小头合并部分滑车骨折延误治疗后成人迟发性尺神经麻痹]

[Late ulnar nerve paresis in adults after neglected treatment for fracture of the capitulum with part of the trochlea in children].

作者信息

Modrzewski K

机构信息

Kliniki Ortopedii AM w Lublinie.

出版信息

Chir Narzadow Ruchu Ortop Pol. 1995;60(1):9-14.

PMID:7736838
Abstract

Etio-pathomorphogenesis of compression syndromes of the ulnar nerve strained over the medial side of the valgus elbow is presented on the basis of follow-up of 11 patients. Valgus deformity of the elbow resulted from neglecting of surgical reduction of the displaced capitulum and part of the trochlea in the childhood. Cartilage of the articular surface of the displaced fragment facing injury site of the humeral condyle impedes healing of the fracture and disturbs the growth of the lateral epiphysis. Thus valgus deformity is accompanied by pseudoarthroses and various deformities of the articular surface. Function of the distorted elbow joint was good, however, and the range of motion pretty wide. An irritation or late paresis of the ulnar nerve appeared only 17 or even 45 years after the fracture in childhood. Permanent ulnar paresis can be prevented by early nerve transposition, that is during first year of ulnar nerve irritation symptoms.

摘要

基于对11例患者的随访,阐述了在肘外翻内侧尺神经受压综合征的病因-病理形态发生机制。肘外翻畸形是由于儿童时期未对移位的肱骨小头和部分滑车进行手术复位所致。移位骨折块关节面的软骨朝向肱骨髁损伤部位,阻碍骨折愈合并干扰外侧骨骺生长。因此,肘外翻畸形伴有假关节形成和关节面的各种畸形。然而,畸形肘关节的功能良好,活动范围相当大。尺神经刺激或迟发性麻痹仅在儿童骨折后17年甚至45年出现。早期神经移位,即在出现尺神经刺激症状的第一年进行神经移位,可预防永久性尺神经麻痹。

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