肘内翻发生机理的再认识（附236例随访分析）

为了进一步认识肘内翻的发生机理，对三家医院收治的５８６例肱骨髁上骨折中发生肘内翻的２３６例患者进行了３～７年，平均５年的随访，并按其进展的程度进行了统计分析。结果显示，肘内翻呈进展性者４０例，非进展性者１９６例。其中８３例解剖复位者，无法用复位不良、固定不当及骨骺损伤等传统观点解释。经仔细分析治疗前后的Ｘ线片，并根据生物力学理论提出了骨膜破裂和骨皮质嵌插、压缩、缺损及塌陷等机械损伤机制，认为临床治疗单纯遵循尺偏型矫枉过正，桡偏型不必强求解剖对位的原则是不够的。应根据其发生机制及Ｘ线表现，分别采取动力性和静力性治疗，以降低肘内翻的发生率。

Second knowledge of the pathogenic mechanism of cubitus varus:A report of 236 cases

Of 586 cases of humeral supracondylar fracture treated in 3 hospitals, 236 cases complicated with cubitus varus were followed up (Range:3-7 years; Mean: 5 years), and counted up and analysed according to the progress severities in order to further find out the pathogenic mechanism of cubitus varus. The results showed that the 236 cases of cubitus varus included 40 cases of progress type and 196 cases of non-progress type. Among them, the cause of 83 cases obtaining anatomic reduction could not be explained by the traditional viewpoints, such as bad reduction, unsuitable fixation, epiphyseal injury and so on. Through the careful analysis of the x-ray films before and after treatment and based on the biomechamical theory, the authors proposed some mechanical mechanisms of the injury, such as periosteal break and cortex impaction, compression, defect and collapse, etc.They believed that in clinical treatment it was not enough only to obey the traditional therapeutic principles, such as overcorrecting for the ulno-deviated type and not forcibly requiring the anatomic reduction for the radio-deviated type. In order to reduce the incidence of cubitus varus,the dynimic-type and static-type therapies should be respectively used according to the pathogenic mechanism and xray findings.