单边轨道式延长外固定支架牵张治疗肱骨短缩合并近端畸形

目的探讨应用单边轨道式延长外固定支架治疗肱骨短缩合并近端畸形的疗效。方法回顾性分析2015年3月至2018年4月上海交通大学附属第六人民医院骨科采用单边轨道式外固定支架治疗的10例肱骨短缩合并近端畸形患者资料。男8例,女2例;年龄15~27岁,平均19.6岁。肱骨短缩伴近端内翻8例,伴肱骨近端内翻并后凸畸形2例;肱骨短缩6~11 cm,平均8.5 cm。上臂外侧置入半钉,安装单边外固定支架,于近端截骨后即时矫正肱骨近端畸形,中段截骨后予以缓慢延长。根据Cattaneo等制定的标准评价肢体功能。结果所有患者术后均获随访,时间15~41个月(平均20个月)。延长长度5~12 cm(平均7.5 cm);肩关节外展幅度平均为160°(130°~180°),比术前(平均90°)改善。9例患者延长区成骨良好,1例因延长区成骨不良,进行了自体髂骨移植后愈合。未出现钉道深部感染、桡神经损伤等并发症。肢体功能根据Cattaneo等的标准:8例9侧肢体为优,2例为良。结论单边轨道式延长外固定支架是治疗肱骨短缩合并近端畸形的可靠选择,掌握外固定支架安装技术,防治并发症可以获得满意的疗效。

Treatment of humeral shortening complicated with proximal deformity with a monorail external fixator

Objective To discuss the key technique and strategy in the treatment of humeral shortening complicated with proximal deformity using a monorail external fixator.Methods We retro-spectively reviewed 10 patients(8 males and 2 females)with humeral shortening and proximal deformity who had been treated by a monorail external fixator between March 2015 and April 2018.Their mean age was 19.6 years(range,from 15 to 27 years).The humeral shortening was complicated with proximal varus in 8 cases,and with proximal varus plus kyphosis in 2.The affected humeri were 6 to 11 cm(mean,8.5 cm)shorter than the normal ones.Half-pins were placed onto the lateral upper arm for installation of a unilateral external fixator to correct the proximal humeral deformity immediately after proximal osteotomy.Gradual lengthening was performed after osteotomy in the middle humeral shaft.The limb function was evaluated by the Cattaneo cri-teria.Results All patients were followed up for 15 to 41 months(mean,20 months).The length of lengthening ranged from 5 to 12 cm(mean,7.5 cm).The range of shoulder abduction averaged 160°(from 130°to 180°),much improved than the preoperative average value(90°).Fine ossification was observed in the lengthening part in 9 patients but dysostosis in the lengthening part occurred in one patient who was healed after iliac autografting.No such complications as pin tract infection and radial nerve injury occurred.Ac-cording to the Cattaneo criteria,9 limbs in 8 cases were excellent and 2 cases good.Conclusions A monorail external fixator is a reliable choice for treatment of humeral shortening complicated with proximal deformity.To obtain satisfactory clinical effects,it is essential to master the installation technique of external fixator and prevent and control complications as well.