保留内侧骨膜的肱骨髁上截骨矫正肘内翻

肘内翻畸形是小儿骨科常见的一种疾病，其病因普遍认为是小儿肱骨髁上骨折，远端向内侧移位而造成。为肱骨髁上骨折的远期并发症。1994年5月～2003年6月，笔者采用保留内侧骨膜的肱骨髁上截骨，2枚克氏针交叉固定，外侧针尾“8”字钢丝加压的方法矫正肘内翻畸形12例，效果良好，现报告如下。     

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     

肱骨髁上“等腰截骨术”治疗肘内翻畸形

肘内翻畸形是儿童肱骨髁上骨折晚期的主要并发症，发生率高，严重者影响外观及功能，自1999年1月～2002年12月，采用肱骨髁上“等腰截骨术”治疗此类患者18例，效果满意，报告如下。     

儿童肱骨髁上骨折并发肘内翻畸形的预防与处理

目的探讨儿童肱骨髁上骨折并发肘内翻畸形的预防方法和处理方式。方法 回顾95例儿童肱骨髁骨折病历资料,分析不同治疗方法的治疗效果和肘内翻畸形的发生率,总结预防儿童肱骨髁骨折合并肘内翻畸形的方法和处理措施。结果本组治疗效果:优63例,占66.3%;良29例,占30.5%;可3例,占3.1%。本组肘内翻畸形发生率:手法复位夹板外固定3例,占9.4%;克氏针内固定0例,开放内固定0例。结论准确的复位和可靠的固定是预防肘内翻畸形并发症的关键;急诊微创克氏针内固定可提高儿童肱骨髁骨折治疗效果并减少肘内外翻畸形发生率。     

儿童肘内翻肱骨髁上截骨丝线内固定术

儿童肘内翻肱骨髁上截骨丝线内固定术王敏戴祥麒张质彬蔡迎天津市天津医院（天津３００２１１）肘内翻是儿童肱骨髁上骨折最常见的合并症，特别是伸直尺偏型骨折。矫正肘内翻畸形最有效方法即是肱骨髁上楔形截骨。以往手术采用钢板或克氏针固定，近年来，我们采用了丝线或...     

肱骨髁上骨折手术方法的改进

肱骨髁上骨折为常见肘部损伤,占小儿肘部骨折的30%～40%,肘内翻是其最常见合并症,尺偏型骨折发生率高达50%.作从1996年至2001年手术治疗伸直型肱骨髁上骨折32 例,采用适当调整携物角和交叉克氏针桡侧张力带内固定的方法,有效地防止了该合并症的发生,报告如下.     

肱骨髁上骨折肘内翻畸形的预防

笔者自1984年至1990年运用矫枉过正复位法治疗肱骨髁上骨折91例,取得了较好的疗效,肘内翻发生率明显降低。现将临床资料报告如下。     

肱骨髁上楔形截骨钢板内固定治疗儿童肘内翻畸形

目的 探讨并总结运用重建钢板治疗儿童肘内翻畸形的临床疗效.方法 回顾分析南方医科大学附属小榄医院2005年6月至2011年7月采用外侧肱骨髁上楔形截骨重建钢板内固定治疗的肘内翻畸形患儿31例,男18例,女13例;年龄6～14岁,平均8.39岁.肘内翻角度25.4°(17°～31°).结果 所有患儿术后畸形矫正良好,获得平均6.2°(3°～20°)提携角.术前与术后提携角比较,有统计学差异(t=1.925,P＜0.05).术后关节活动范围平均125°(90°～135°),与术前相比无明显改变.术后随访时间1～3年(平均2.6年),无一例复发,无骨化性肌炎发生.所有病例均无血管损伤、感染等并发症发生,术后肌力正常,1例并发尺神经损伤,经保守治疗2个月后改善,2例旋转轻度障碍,14例肱骨外髁处出现隆起.肱骨截骨处平均骨性愈合时间为3.4个月(3～4个月),所有病例均未出现内固定松动现象,拆除内固定时间为15个月(8～l8个月).结论 尽管侧方肱骨髁上楔形截骨重建钢板内固定治疗儿童肘内翻畸形可能发生肱骨远端外侧突起、肘关节外侧瘢痕等并发症,但是术后总体疗效满意,是一种可以广泛应用的术式.     

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.     

Supracondylar medial open wedge osteotomy with external fixation for cubitus varus deformity

BACKGROUND: Many surgical procedures are used for the correction of cubitus varus deformity in children. Even if the primary indication is cosmetic, but many poor results have been described. The technique of a supracondylar medial opening wedge osteotomy with external fixation is presented and preliminary results in four cases are reported. TECHNIQUE: An antero-medial approach is chosen with exposition and anterior transposition of the ulnar nerve. Under image intensifier control, insertion of four Schanz screws is performed from medial to lateral. In between, an incomplete medial osteotomy is performed obliquely (in the antero-posterior as well as in the medio-lateral plane), leaving a small part of the radial humeral cortex intact. The osteotomy is opened until varus and, if present, hyperextension deformation are corrected. Then, the fixator system is applied. RESULTS: All osteotomies healed primarily. Mean valgus correction of 21.75 degrees was achieved; in only one patient additional flexion modification of 17 degrees was necessary. At a follow-up of at least 2 years clinically three out of four presented symmetric elbow position, one slight residual varus deformity was noted in spite of 20 degrees of valgization due to important valgus position of the contralateral side. No lateral bulging of the corrected elbow was observed. CONCLUSION: The described technique is an alternative to other procedures, with special regard to the cosmetic outcome as well as to the control of correction for valgus and flexion.     

Supracondylar osteotomy of the humerus for correction of cubitus varus

Reports of corrective procedures for cubitus varus (gunstock deformity) have emphasized the frequency of loss of position and significant complication. Modifications that have been made to the standard supracondylar osteotomy protocol include correction of the angular deformity only, without correction of rotation; an incomplete wedge osteotomy leaving the medial cortex intact by hinging the osteotomy shut on the intact cortex; and immobilization of the elbow in full extension with the forearm supinated. In a review of 16 patients following this protocol, 11 patients had excellent results, three had good results, and two had unsatisfactory results.     

Supracondylar osteotomy of the humerus for correction of cubitus varus

Cubitus varus is the most common complication of supracondylar fracture of the humerus in children. Although function of the elbow is not greatly impaired, the deformity is unsightly. It usually results from malunion, since growth disturbance of the humerus after this fracture is uncommon. The normal carrying angle can be restored by supracondylar osteotomy. This operation was done in 32 patients over a ten-year period, 16 of them using the technique described by French (1959). The results in 27 patients are reviewed in the light of previous reports. French's method proved safe and satisfactory.     

Supracondylar humeral osteotomy in children with severe posttraumatic cubitus varus deformity

The authors report the results of corrective osteotomy of the humerus in 11 children with severe posttraumatic cubitus varus deformity. The average carrying angle on the affected side was -24.4 degrees, and there was an average internal rotation deformity of the distal humerus of 22 degrees. Flexion and extension of the injured elbow were severely limited. A supracondylar lateral wedge osteotomy of the humerus was performed keeping the medial cortex intact. Two K-wires served as levers to correct the angular and rotational deformity of the elbow and then as fixation material to hold the osteotomy fragments. Postoperatively we immobilized the elbows in 90 degrees flexion for 3 to 4 weeks. There was no loss of the postoperative osteotomy alignment in most cases. Recurrence of mild varus deformity (-5 degrees and -7 degrees) occurred in only two patients. At the end of the follow-up we observed excellent results in 9 patients with an average carrying angle of 7.2 degrees (range 5-10 degrees).     

外侧闭合楔形截骨术矫正儿童创伤性肘内翻畸形

目的探讨采用外侧闭合楔形截骨术矫正儿童创伤性肘内翻畸形的疗效。方法 1996年7月-2010年6月,收治儿童肱骨髁上骨折后肘内翻畸形20例。男13例,女7例。年龄7～14岁,平均10.6岁。左侧12例,右侧8例。13例曾于外院行闭合复位经皮克氏针内固定、石膏外固定,7例误诊为关节脱位和软组织损伤行石膏外固定。伤后2～12年出现肘关节外观异常和活动受限。术前肘关节活动范围为屈100～150°,平均133.0°;伸0～24°,平均11.7°。肘内翻角度为20～50°,平均32.1°。均采用外侧闭合楔形截骨术治疗。结果术后切口均Ⅰ期愈合,无相关并发症发生。17例患儿获随访,随访时间1～14年,平均5年。X线片示截骨区均达骨性愈合,愈合时间为5～8周,平均6周。肘关节内翻畸形均获矫正,末次随访时肘关节活动范围为屈110～150°,平均135.9°;伸0～27°,平均12.9°。根据Jupiter等肘关节评分系统评价肘关节功能,优14例,良2例,可1例,优良率94.1%。1例术后1个月拔除克氏针后畸形复发,1年后再次行外侧闭合楔形截骨术矫正。结论外侧闭合楔形截骨术具有操作简便、手术并发症少等优点,是治疗儿童创伤性肘内翻畸形有效方法之一。     

内固定治疗成人陈旧性肱骨内髁骨折合并肘内翻1例

1病例资料 患者,男,46岁。因骑车摔伤致右肘关节疼痛、活动受限1h,在外院急诊行切开复位螺钉内固定术,术后4个月出现右肘畸形,活动受限。于2008年3月转入我院。诊断：右肱骨内髁陈旧性骨折合并肘内翻。查体：右肘部内侧可见长约8cm手术瘢痕。     

不同内固定方式治疗儿童肘内翻畸形的疗效

目的探讨不同内固定方式治疗儿童肘内翻畸形的疗效。方法将47例儿童肘内翻畸形患者按固定方法分成两组,均先行肱骨髁上不全楔形截骨,然后分别采用传统克氏针内固定(A组,24例)和骑缝钉内固定(B组,23例)。比较两组术后骨性愈合时间及术后3个月肘关节功能恢复幅度。结果患儿均获得随访,时间12~24个月。无一例出现肘内翻复发。骨性愈合时间:A组3~3.5(3.1±0.2)个月,较B组的2.2~3.2(2.7±0.4)个月长(P0.05);术后3个月肘关节功能恢复幅度:A组135°~154°(144.5°±7.7°),较B组的155°~175°(164.3°±7.3°)小(P0.05)。结论采取骑缝钉内固定治疗儿童肘内翻内固定可靠,骨折端愈合较快,肘关节功能恢复快,安全有效。     

Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity

Between 1958 and 1983, 45 corrective supracondylar osteotomies of the humerus were performed for post-traumatic cubitus varus deformity in 43 children. The average follow-up period was two and one-half years. Excellent or good results were obtained in 33 patients. Unsatisfactory results were seen in 12. The operation, though deceptively simple, had a significant complication rate (24%), including neuropraxia, sepsis, and cosmetically unacceptable scarring. After these problems were analyzed, the important points of technique that were noted were a comprehensive preoperative plan and a simple lateral closing wedge osteotomy, leaving the medial cortex intact and ignoring rotational deformity.