外侧闭合楔形截骨并交叉穿针皮外张力带固定治疗儿童肘内翻畸形

目的:探讨外侧闭合楔形截骨并交叉穿针外张力带固定治疗儿童肘内翻畸形的疗效。方法:2011年3月至2015年6月手术治疗肘内翻畸形儿童26例,其中男15例,女11例;年龄4~13岁,平均7.8岁;术前内翻角度11°~24°,平均(17.50±6.73)°,其中3例较健侧屈曲受限角度10°。均采用肘外侧切口,行肱骨远端髁上外侧闭合楔形截骨,保留内侧3~4 mm宽度的连续皮质,截骨对合后采用交叉克氏针穿针并皮外张力带(交叉针皮外部分在外侧反向折弯并针尾再返折相互钩绕)固定,截骨端外侧形成加压,术后随访比较治疗前后和健侧提携角,采用Laupattarakasem标准评价疗效。结果:26例均于术后2个月内骨性愈合,无感染和神经麻痹等并发症,随访时间13~29个月,平均18.8个月,提携角恢复为8°~14°,平均(11.50±3.17)°。Laupattarakasem标准评定术后优14例,良11例,可1例。结论:采用外侧闭合楔形截骨可以有效恢复肘内翻畸形,交叉穿针并皮外张力带固定可以满足术后早期活动要求。

Lateral closing wedge osteotomy and modified cross pinning with external tension band fixation in the treatment of cubitus varus deformity in children

Objective: To explore the therapeutic effects of distal humeral lateral closing wedge osteotomy followed by modified pinning combined with external tension band fixation in the treatment of cubitus varus deformity in children.Methods: Total 26 adult patients with cubitus varus deformity were treated by operation from March 2011 to June 2015,15 patients were boys and the other 11 patients were girls,ranging in age from 4 to 13 years,with an average of 7.8 years. The cubitus varus angel ranged from 11 degrees to 24 degrees,with a mean(17.50±6.73) degrees,3 patients complicated more than 10 degrees constriction of flexion. Lateral closing wedge osteotomy retaining the medial 3 to 4 mm intact cortex by lateral elbow approach was applied in these 26 patients. The wedge defect were closed and fixed by crossing pinning. The lateral column compression was achieved with external tension band(the crossing pins were bended laterally and the pin ends were hooked mutually). The pre-operative,post-oparetive and contralateral carrying angles were compared and Laupattarakasem criteria was used to evaluate the results at follow-up.Results: All the patients got bony union 2 months after operation and there was no infection or nerve palsy. The average follow-up period was 18.8 months (ranged,13 to 29 months). The carrying angle was restored to(11.50±3.17) degrees(ranged,8 to 14 degrees). According to the Laupattarakasem evaluation criteria,14 patients got an excellent result,13 good and 1 fair.Conclusion: Normal carrying angle and elbow flexion could be restored by lateral closing wedge osteotomy,and stable fixation could be achieved with crossing pinning and external tension band,which is available for early mobilization.