肱骨外髁骨折是低龄儿童常见肘部损伤之一。损伤机制主要为肘关节伸直时前臂在内翻或外翻应力下发生。大部分情况下,X线可以明确诊断,但对于没有移位及外髁尚未骨化骨折,MRI或肘关节造影可以进一步明确诊断。对于骨折移位 ≤ 2 mm且关节面平整的患儿首选保守治疗。闭合复位经皮克氏针固定适用于骨折移位 > 2 mm且关节面铰链完整者。而骨折块移位 ≥ 4 mm伴骨折块翻转,关节面不平整者,首选切开复位内固定治疗。主要并发症包括畸形愈合、延迟愈合、鱼尾畸形、外侧过度生长及生长停滞。本文旨在对儿童肱骨外髁骨折进行全面概述,以提高广大基层医生对儿童肱骨外髁骨折的认识及为患儿选择最合理的治疗方式。Humeral lateral condyle fracture is one of the most common elbow injuries in young children. The injury mechanism mainly occurs under varus or valgus stress of the forearm during elbow extension. In most cases, X-ray can confirm the diagnosis, but MRI or elbow arthrography can further confirm the diagnosis of fractures without displacement or ossification of the lateral condyle. Conservative treatment is the first choice for children with fracture displacement ≤ 2 mm and flat articular surface. Closed reduction and percutaneous Kirschner wire fixation suitable for patients with fracture displacement > 2 mm and intact articular surface hinge. Open reduction and internal fixation are the first choice for patients with fracture displacement ≥ 4 mm, inversion of fracture fragment and uneven articular surface. The main complications included malunion, delayed union, fishtail deformity, lateral overgrowth and growth arrest. This article aims to provide a comprehensive overview of pediatric humeral condyle fractures, in order to improve the understanding of primary care doctors towards pediatric humeral condyle fractures and to select the most reasonable treatment methods for children.
目的:通过Meta分析系统评价螺钉及克氏针内固定治疗儿童肱骨外髁骨折的临床疗效。方法:计算机检索PubMed、Embase、Cochrane、Web of Science、中国知网、万方数据库建库至2022年2月国内外发表的有关螺钉和克氏针内固定治疗儿童肱骨外髁骨折的文献。根据设定的纳入与排除标准筛选文献并进行质量评价,结局指标为愈合优良率、畸形愈合率、延迟愈合率或骨不连率、感染率、活动受限(>10°)发生率,使用RevMan 5.3软件进行统计分析。结果:共纳入9项回顾性研究涉及647例患者,其中螺钉固定组(含螺钉联合克氏针)255例,克氏针固定组392例。Meta分析显示,与克氏针组相比,螺钉组(含螺钉联合克氏针)在术后有更低的感染率[OR=0.22,95%CI(0.09,0.56),P=0.001]。两组间愈合优良率、畸形愈合率比较,差异均无统计学意义(P>0.05)。亚组分析显示,单纯螺钉组术后感染率显著低于克氏针组[OR=0.18,95%CI(0.05,0.65),P=0.009]。结论:对于手术治疗儿童肱骨外髁骨折,与克氏针内固定和螺钉联合克氏针内固定相比,单纯螺钉内固定拥有更低的感染率。而在愈合优良率、畸形愈合率方面三者无显著差异。就术后疗效及内固定安全性方面而言,更推荐骨科医师使用螺钉进行儿童肱骨外髁骨折的固定。
