摘要目的 介绍漏诊后的青少年肱骨小头骨折常出现畸形愈合、关节僵硬等严重并发症,本文拟介绍其诊断和治疗的经验和方法.方法 回顾性分析2010年7月-2015年3月笔者治疗的6例漏诊后的陈旧性肱骨小头骨折患者的病例资料及随访结果,其中,男5例,女l例;平均年龄(14.33±1.86)岁,左侧4例,右侧2例.受伤至手术平均时间为(8.67±3.88)个月.结果 术前平均屈肘(91.67°±7.53°),平均伸肘(40.0°±8.94°),屈伸活动范围平均为(51.67°±11.69°).前臂旋转无受限.术前MEPS评分平均为(80.83±4.92)分.对前后方关节囊进行彻底松解,其中 3例附加内侧切口进行松解复位骨折块,并以HCS固定.通过缝合锚(2例)或经骨缝合(4例)修复外侧副韧带及伸肌腱止点.其中3例附加Stryker DJ-DⅡ代铰链式外固定支架,8 周拆除.术后随访7～ 64个月,平均(39.33±20.42)个月,骨折愈合良好,平均屈肘(138.33°±7.528°),平均伸肘(5.0°±4.472°),屈伸活动范围平均为(133.33°±9.832°) 前臂旋转无受限.MEPS评分平均为100分.结论 青少年肱骨小头骨折易漏诊,造成骨折畸形愈合、关节僵硬等并发症.通过关节彻底松解,骨折端截骨重新内固定,修复外侧副韧带,必要时附加可活动铰链式外固定支架,可改善患者的肘关节功能.

abstractsObjective To introduce the diagnosis and treatment of the missed adolescent humeral capitellar fracture malunion.Methods Retrospectively analyzed 6 cases with missed adolescent capitellar fracture malunion treated by the author from Jul.2010 to Mar.2015 and their follow-up results.Among them, 5 were male and 1 was female.The average age is (14.33 ± 1.86) years, 4 were left-side and 2 were right.Results The average time from injury to the operation is (8.67 ± 3.88) months.Before operation, the average elbow flexion was (91.67° ±7.53°), the average elbow extension was (40.0° ± 8.94°), the average range of flexion and extension activities was (51.67° ±11.69°).Forearm rotation was not limited.Average M EPS score was (80.83 ± 4.92).Released the elbow in 3 cases with additional medial incision.The fragment was fixed by HCS.The lateral collateral ligament was repaired by suture anchors (2 cases) or by trans-os suture(4 cases).Three cases were fixed by DJDⅡ Stryker hinged external fixatorswhich were removed after 8 weeks.The average postoperative follow-up time was (39.33 ± 20.42) months.Postoperatively, the average elbow flexion was (138.33° ±7.528°), the average elbow extension was (5.0° ± 4.472°), the average range of flexion and extension activities was (133.33° ±9.832°).Forearm rotation is not limited.The average MEPS score was 100.Conclusions The adolescent capitellar fracture is prone to be missed and cause malunion, elbow stiffness or other complications which is very difficult to deal with.By complete elbow release, osteotomy and internal fixation, the lateral collateral ligament repair, and hinged external fixator if necessary, the final elbow function can be improved.