单纯闭合楔形截骨术治疗儿童肘内翻畸形

目的探讨儿童肘内翻畸形的手术治疗方法.方法回顾30例采用无内固定的肱骨髁上闭合楔形截骨术治疗的肘内翻畸形,其中男27例、女3例,平均随访5年,最长达8年.结果术前患侧提携角平均-25°,术后提携角平均6.83°,术后较术前平均改变31°,无复发及神经损伤、感染等并发症的出现.结论无内固定的单纯闭合楔形截骨术手术时间短、患者创伤小、避免二次手术,是简便、安全、有效的治疗儿童肘内翻的方法.     

单纯闭合楔形截骨术治疗儿童肘内翻畸形

目的:探讨儿童肘内翻畸形的手术治疗方法。方法:回顾30例采用无内固定的肱骨髁上闭合楔形截骨术治疗的肘内翻畸形,其中男27例、女3例,平均随访5年,最长达8年。结果:术前患侧提携角平均-25°,术后提携角平均6.83°,术后较术前平均改变31°,无复发及神经损伤、感染等并发症的出现。结论:无内固定的单纯闭合楔形截骨术手术时间短、患者创伤小、避免二次手术,是简便、安全、有效的治疗儿童肘内翻的方法。     

肱骨髁上楔形截骨钢板内固定治疗儿童肘内翻畸形

目的　探索改进肘内翻手术内固定技术的方法。方法　取上臂远端外侧直切口 ,暴露肱骨截骨面。截骨前在截骨线近侧用 1枚螺钉将钢板固定 ,但不拧紧螺钉。将钢板旋向肱骨近侧 ,露出截骨线后作肱骨髁上楔形截骨。分别自截骨线远侧和近侧各拧入 1枚螺钉。术后用长臂石膏托固定于屈肘 90°、前臂中立位 3周。结果　 12例患儿畸形均矫正并有平均 4 .8°提携角 ,无神经血管损伤等并发症。随访 1～ 3年 ,所有病例无复发。结论　采用三孔小钢板作肘内翻截骨后内固定损伤小、操作简单、固定确实 ,手术效果良好     

楔形截骨钢丝内固定矫治肘内翻畸形

我院自１９８８年８月～１９９５年８月收治２６例由肱骨髁上骨折造成的肘内翻畸形,行楔形不全截骨钢丝内固定治疗,疗效满意,报告如下。临床资料本组２６例中男１８例,女８例;年龄６～１２岁,平均９岁。左侧１５例,右侧１０例,双侧１例。均为闭合性伸直型骨折,早...     

改良截骨植骨低切迹内固定治疗肘内翻畸形

肱骨髁上骨折、肱骨远端全骨骺分离、肱骨内髁骨骺损伤等均可能发展至肘内翻畸形，出现上肢力线异常、肘关节疼痛、屈肘乏力，并且可引起骨性关节炎，同时影响外观，常需进行手术矫形治疗。方法上采用截骨加内固定术，有多种截骨和内固定术式。我院1998—2003年采用肱骨髁上改良截骨自体骨植骨螺钉钢丝低切迹加压内固定辅以中药熏洗治疗青少年肘内翻21例，经过随访证实疗效满意，现报告如下。     

小切口后外侧入路外侧闭合楔形截骨锁定钢板治疗成人肘内翻畸形

目的探讨小切口后外侧入路外侧闭合楔形截骨锁定钢板治疗成人肘内翻畸形的疗效。方法回顾性分析2013年7月至2017年9月期间武汉市第四医院手外一科收治的19例成人肘内翻畸形患者资料。男3例,女16例;年龄17~27岁,平均20.3岁;左侧13例,右侧6例;肘内翻角为20.7°±2.8°。所有患者术前在医学影像存档和传输系统(PACS)上精确测量健侧提携角及患侧的内翻角,并测算出截骨角度,术中采用小切口后外侧入路,外侧闭合楔形截骨矫形锁定钢板固定。末次随访时测量患肘提携角并采用Mayo肘关节功能评分标准(MEPS)评定肘关节功能,采用Bellemore方法评定肘矫形手术疗效。结果19例患者术后获9~32个月(平均14个月)随访,所有患者截骨处均愈合良好。末次随访时患肘提携角为11.4°±1.6°,患者手术瘢痕平均4 cm(3~5 cm),术后患肢肘内翻畸形与术前对比明显改善,肘关节功能良好。术后采用MEPS评定肘关节功能:优10例,良7例,中2例;采用Bellemore方法评定肘矫形手术疗效:优13例,良6例。2例患者术后出现尺神经部分损伤,1例患者术后出现轻度肘关节僵硬。所有患者随访期间未出现内固定物松动、断裂等失效情况,无一例出现骨折延迟愈合及不愈合。结论术前应用PACS系统精确测量截骨角度,术中应用小切口后外侧入路进行外侧闭合楔形截骨矫形,既确保了矫形角度和术后肘关节功能恢复,又未留下明显手术瘢痕,外形美观,疗效良好。     

青少年肘内翻畸形的手术治疗

１临床资料１９８７～１９９６年采用肱骨髁上楔形截骨及２枚螺钉加“８”字形钢丝内固定治疗青少年肘内翻患者３３例。男２４例，女９例；年龄５～１５岁，平均９岁。均为外伤性肱骨髁上骨折致肘内翻畸形。手术治疗时间：６个月以内者１８例，１年以内者１５例。肘内翻角...     

The correction of post-traumatic cubitus varus by hemi-wedge osteotomy

Summary Osteotomy was performed for cubitus varus deformity in 14 patients following supracondylar fracture of the humerus. In the first four patients the osteotomy was performed by a standard wedge technique and in the last ten cases by a new technique of hemiwedge osteotomy. The hemi-wedge technique permitted better control of the correction and better fixation of the osteotomy. Before the operation all cases had a cubitus varus of 10° or more. After the operation all but one patient had a normal carrying angle or at most a cubitus varus of 5°. In this case the standard osteotomy failed because of poor fixation and after re-operation by the hemi-wedge osteotomy because of infection.

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Résumé Chez 14 malades, une déformation en cubitus varus, après fracture supracondylienne de l'humérus, a été traitée par ostéotomie. Dans les quatre premiers cas, les auteurs ont réalisé une ostéotomie cunéiforme standard et dans les dix derniers cas, ils ont eu recours à une nouvelle technique d'ostéotomie hémicunéiforme. Cette technique permet un meilleur contrôle de la correction et une meilleure fixation de l'ostéotomie. Avant l'opération, le cubitus varus était, dans tous les cas, de 10° ou davantage. Après l'opération, tous les malades sauf un avaient retrouvé un angle brachio-antibrachial normal, ou, tout au plus, un cubitus varus de 5°. Dans ce cas, l'ostéotomie standard avait échoué en raison d'une fixation insuffisante, ainsi que la réintervention par ostéotomie hémicunéiforme à cause d'une infection postopératoire.

     

Lateral closed wedge osteotomy for cubitus varus deformity

Background:

Lateral closed wedge (LCW) osteotomy is a commonly accepted method for the correction of the cubitus varus deformity. The fixation of osteotomy is required to prevent loss of correction achieved. The fixation of the osteotomy by the two screw and figure of eight wire is not stable enough to maintain the correction achieved during surgery. In this prospective study we supplemented the fixation by Kirschner''s (K-) wires for stable fixation and evaluated the results.

Materials and Methods:

Twenty-one cases of the cubitus varus deformity following supracondylar fractures of the humerus were operated by LCW osteotomy during February 2001 to June 2006. The mean age of the patients at the time of corrective surgery was 8.5 years (range 6.6-14 years). The osteotomy was fixed by two screws with figure of eight tension band wire between them and the fixation was supplemented by passing two to three K-wires from the lateral condyle engaging the proximal medial cortex through the osteotomy site.

Result:

The mean follow-up period was 2.5 years (range seven months to 3.4 years). The results were assessed as per Morrey criteria. Eighteen cases showed excellent results and three cases showed good results. Two cases had superficial pin tract infection.

Conclusion:

The additional fixation by K wires controls rotational forces effectively besides angulation and translation forces and maintains the correction achieved peroperatively.     

成人创伤后肘内翻畸形的矫形及双柱固定

目的探讨肱骨髁上截骨双钢板固定治疗成人创伤后肘内翻的方法及疗效。方法回顾性分析2007年6月-2010年12月手术治疗22例成人创伤后肘内翻畸形患者的临床资料。其中男16例,女6例;年龄18～29岁,平均21岁。既往均有肱骨髁上骨折病史;初次骨折后3个月～1年,平均6个月出现肘内翻畸形;出现畸形后4～17年,平均8年入院手术。术前患侧肘关节提携角为肘内翻16～25°,平均20.6°。肘关节功能采用Flynn评分均为差。术中行肱骨外侧闭合楔形截骨,以2块重建钢板塑形后分别置于肱骨内外侧柱以固定截骨断端。术后无需外固定,早期行功能锻炼。结果术后切口均Ⅰ期愈合。22例均获随访,随访时间6～24个月,平均13个月。末次随访时患侧肘关节提携角为肘外翻0～10°,平均7.5°。患者截骨处均骨性愈合,愈合时间8～13周,平均10周。术后无感染,神经、血管损伤,内固定物松动、断裂等并发症发生,无肘内翻复发。末次随访时Flynn评分优17例,良3例,中2例,优良率91%。结论采用肱骨髁上截骨加双钢板固定治疗成人创伤后肘内翻畸形,固定坚强,骨折愈合率高,术后能早期功能锻炼,肘关节功能恢复满意。     

早期手术矫形对儿童肱骨髁上骨折后肘内翻畸形的影响

目的】探讨早期截骨矫形手术对儿童肘内翻畸形病理形态和肘关节功能的影响。方法收集我科2003年1月～2005年12月收治的137例截骨矫形手术治疗的儿童肘内翻畸形患者的临床和随访资料,根据创伤后手术时间不同分成两组:A组(创伤后二年内手术组)62例和B组(创伤后二年以上组)75例,进行分析。结果A组患者术前提携角为-25.42°±4.57°,术后提携角为10.17°±3.09°,关节屈伸功能改善21.26°±5.15°,X线病理形态改善接近正常者48例,B组患者术前提携角为-24.68°±6.07°,术后提携角为9.24°±3.43°,关节屈伸功能改善角度为13.29°±6.22°,X线病理形态改善接近正常者32例,两组患者均未出现肘内翻畸形复发、骨折不愈合、神经损伤等并发症。结论儿童肘内翻畸形尽早手术矫形能够早期恢复上肢力线和肘关节运动轴,有利于肘关节病理形态的修复,而且在矫正畸形的同时改善关节功能。     

肱骨髁上等腰三角形截骨联合锁定钢板内固定治疗大龄儿童肘内翻

目的探讨肱骨髁上等腰三角形截骨的优点以及联合成人桡骨远端L形锁定钢板内固定治疗大龄儿童肘内翻的临床疗效。方法自2008-01—2013-01采用肱骨髁上等腰三角形截骨联合成人桡骨远端L形锁定钢板内固定治疗儿童肘内翻21例。截骨方式设计为肱骨髁上等腰三角形截骨,术前设计截骨图纸,依据截骨角度(截骨角度=健侧提携角+肘内翻角)计算等腰三角形截骨外侧底边的长度。结果本组手术时间20~35 min,平均24.5 min;术中失血量15~30 ml,平均25.3 ml。21例均获得随访28~60个月,平均36个月。疗效依据Flynn肘关节功能评分标准并综合屈伸功能评价:优18例,良2例,可1例,优良率95.2%。末次随访时提携角0°~13°(9.20±1.21)°,肘关节屈伸活动范围0°~130°。结论采用肱骨髁上等腰三角形截骨联合成人桡骨远端L形锁定钢板内固定治疗大龄儿童肘内翻出血量少,肘关节外侧骨突畸形改善明显,内固定确切,可有效防止截骨角度丢失,并有利于肘关节早期功能锻炼,关节功能恢复满意。     

Correlation between posteromedial or posterolateral displacement and cubitus varus deformity in supracondylar humerus fractures in children

Purpose Cubitus varus deformity is one of the most common complications after displaced supracondylar humeral fractures in children. The purpose of this study was to evaluate the relationship between the fracture displacement and cubitus varus deformity in displaced supracondylar humerus fractures. Methods Seventeen patients (11 males/6 females; mean age 7 years) with cubitus varus deformities occurring after Gartland type III posteromedial or posterolateral displaced supracondylar humerus fractures were evaluated with clinical and serial radiographic examinations. All patients had been treated surgically by open reduction through a medial approach and percutaneous cross-pinning. All fractures were reduced anatomically. Ten of the patients were operated within the first 24 h. The time interval between the initial injury and the surgical procedure for the remaining seven patients was 5.3 days on average (range 2–10 days). The carrying angle and range of motion of the elbow were measured throughout the follow-up period. The mean follow-up time was 3.7 years (range 2–12 years). Results Five patients with type III-B fractures had a mean carrying angle loss of 8.8° (range 6–10°), whereas for the remaining 12 type III-A patients the mean loss was 15° (range 6–29°) (P = 0.019). None of the patients in this study demonstrated limited elbow motion. According to the Flynn criteria, the results were good in five type III-B patients. There was no statistically significant relationship between the loss of carrying angle and the delay before the surgical procedure (P = 0.615 in type III-A, P = 0.096 in type III-B). Conclusions The carrying angle loss was more significant in type III-A fractures compared with type III-B in this series. These results suggest that although anatomic reduction has been achieved by surgical treatment without loss of reduction, there is still a risk for cubitus varus deformity for type III-A fractures due to the initial compression of the medial column or, in other words, physeal injury.     

肱骨髁上截骨张力带固定治疗成人肘内翻畸形

<正>肘内翻是肱骨髁上骨折后常见的晚期并发症[1-4]。自2006年1月至2008年12月,采用肱骨髁上截骨张力带固定治疗成人肘内翻畸形31例,疗效满意,现报告如下。