倒“V”复合截骨术治疗成人肘关节内翻畸形疗效分析

背景:肘关节内外翻畸形是肱骨髁上骨折的常见并发症,发生率为10%~50%。肘关节畸形可导致肘关节不稳定、尺神经麻痹可能,需要手术矫正。目的:探讨倒“V”复合截骨术治疗成人肘关节内翻畸形的疗效。方法:回顾性分析2015年4月至2018年9月收治的肘关节内翻畸形患者27例。肱骨髁上骨折不愈合4例,无法追溯骨折类型23例。利用倒“V”复合截骨术矫正肘关节畸形。分析矫正前后肘关节畸形角度、活动度改变情况,以改良Mayo评分评估患者术后肘关节功能。结果:所有患者均得到随访,随访时间6~28个月,平均(16.9±7.2)个月,平均愈合时间(4.1±0.6)个月。术前肱-肘-腕角为(-19.8±4.3)°,术后为(5.9±3.6)°,两者差异有统计学意义(P<0.05),矫正角度15°~35°,平均(25.7±5.2)°。所有患者无切口愈合不良、骨不连、内固定松动断裂,所有患者均达到骨性愈合,未出现矫正丢失情况,4例患者矫正术后存在直肘情况;所有患者在术后康复锻炼过程中可达到术前的肘关节活动度,术后3个月肘关节活动度与术前无明显差异。术后3个月改良Mayo肘关节评分为(91.7±4.9)分,其中优20例,良5例,可2例,总优良率92.6%(25/27)。结论:倒“V”复合截骨术治疗肘关节内翻畸形切实可靠,矫正效果良好,有利于患者肘关节活动度及功能恢复,在治疗肘关节内翻畸形上有一定疗效,但存在截骨术前设计方案与实际操作不安全匹配的缺点。

Reverse V complex osteotomy in treatment of adult's cubitus varus

Background:Cubitus varus or valgus are the common complications of humorous supracondylar fracture with the incidence between 10%and 50%.The deformity may lead to elbow instability and ulnar nerve palsy,so it requires surgical cor rection.Objective:To explore the efficacy of reverse V complex osteotomy in treatment of elbow varus in adults.Methods:A to tal of 27 patients with elbow varus admitted in our hospital from April 2015 to September 2018 were selected for this retrospec tive review aging from 17 to 39 years with the average of(27.5±6.0)years old,including 10 men and 17 women.4 patients had supracondylar fracture of humerus nonunion and 23 patients had unknown juvenile fracture types.All patients underwent re verse V complex osteotomy to correct elbow deformity.The deformity angle and change of range of motion(ROM)before and af ter the operation were compared.Elbow function was evaluated by modified Mayo scoring.Results:All patients were followed up for 6-28 months with the average of(16.9±7.2)months.The mean healing time was(4.1±0.6)months.The humerus-elbowwrist angle(HEWA)was-19.8°±4.3°and 5.9°±3.6°before and after the operation with the mean correction angle of 25.7°±5.2°(range,15°-35°),and the difference was statistically significant(P<0.05).None of the patients had poor wound healing,bone nonunion and internal fixation loosening and broken.All patients had bone union and no correction loss.4 patients had straight elbow after operation.Elbow ROM in the course of rehabilitation exercise after the operation reached the degree before the operation,and there was no statistically significant difference between pre-operation and 3 months after the operation.Postoperative modified Mayo score was(91.7±4.9)and the overall excellent and good ratio was 92.5%including 20 cases excel lent,5 cases good,and 2 cases fair.Conclusions:Reverse V complex osteotomy is reliable in correcting the elbow varus and has a good correction result without any impact on ROM and function of elbow.However,it has the shortness that the designed surgical program and the actual implementing program are not completely same.