肘关节造影在儿童陈旧性桡骨头脱位治疗中的应用价值

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摘要目的探讨和分析肘关节造影在儿童陈旧性桡骨头脱位治疗中的应用价值。方法 2014年1月至2017年1月，共收治15例陈旧性桡骨头脱位儿童，男11例，女4例；年龄3～11岁，平均9岁。术中行肘关节造影来观察桡骨头与关节囊的位置。通过手术打开关节囊，来证实桡骨头的脱位性质。采用尺骨近端截骨复位桡骨头，钢板螺钉固定截骨断端治疗。结果通过肘关节造影，12例桡骨头位于关节囊内，3例桡骨头位于关节囊外。打开关节囊，先天性桡骨头脱位的桡骨头与肱骨小头之间没有瘢痕组织，桡骨头凹浅平；而创伤性脱位的桡骨头与肱骨小头之间有明显的瘢痕组织，桡骨头凹明显。其中8例先天性桡骨头脱位病例桡骨头均位于关节囊内。7例创伤性脱位中4例桡骨头位于关节囊内，3例位于关节囊外。经过9个月至3年8个月，平均2年4个月的随访，术后没有桡骨头再脱位或半脱位情况发生。结论肘关节造影对于鉴别诊断桡骨头脱位有一定的辅助价值。尺骨近端截骨是治疗儿童陈旧性桡骨头脱位的一种有效方式。

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关键词 ：肘关节造影, 儿童, 桡骨头, 脱位, 诊断

Abstract：Objective To discuss and analyze the application value of elbow anthrography in the treatment of chronic radial head dislocation in children.Methods There were 15 cases of old anterior dislocation of radial head，including 11 boys and 4 girls.The average age was 9 years old(3~11 years).The elbow arthrography was used to judge the relationship of the radial head and elbow capsule.The character of the dislocation was confirmed by opening the elbow capsule to observe the relationship of the radial head and capitellum，and to observe the shape the radial head.The proximal ulna was performed osteotomy for the reduction of the radial head.The plate and screws were used to fix the osteotomy cite.Results The radial heads were in the capsule in 12 cases and out of the capsule in 3 cases.There was no scar tissue between the radial head and capitellum in congenital cases when opening the joint capsule.The surfaces of radial heads were flat.Obvious scar tissue was between the radial head and capitellum in traumatic cases.The surfaces of radial heads were hollowed.The radial head and capitellum were in the same joint capsule in all congenital cases.The radial head were not in the joint capsule of 3 traumatic cases and in the joint capsule of 4 traumatic cases.Through average 2 years 4 months follow up，there were no redislocation or subluxation occurred.Conclusion Elbow arthrography has the assistant role to judge the dislocation of the radial head from congenital to traumatic reasons.Osteotomy of proximal ulna is an effective way to treat chronic dislocation of radial head in children.

Key words： arthrography children radial head dislocation diagnosis

基金资助:西安市卫生和计划生育委员会科研项目资助(J201702021)

作者简介: 姜海(1975－ )，男，副主任医师，西北妇女儿童医院儿骨科，710061。

引用本文:

姜海 1，苗武胜 2，吴革 2，汪兵 2，吴永涛 2，屈继宁 2，李敏 2. 肘关节造影在儿童陈旧性桡骨头脱位治疗中的应用价值[J]. 实用骨科杂志, 2018, 24(4): 302-305.
Jiang Hai 1，Miao Wusheng 2，Wu Ge 2，et al. Application Value of Elbow Anthrography in the Treatment of Chronic Radial Head Dislocation in Children. sygkzz, 2018, 24(4): 302-305.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I4/302

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