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。

Adult cubitus varus treated by lateral closed wedge osteotomy plus locking plating via a small incision and posterior lateral approach

Objective To explore the effects of lateral closed wedge osteotomy plus locking plating via a small incision and posterior lateral approach on adult cubitus varus.Methods A retrospective analysis was conducted of the 19 adults with cubitus varus who had been admitted to Department of Hand Surgery,Wuhan Fourth Hospital from July 2013 to September 2017.They were 3 males and 16 females,aged from 17 to 27 years(average,20.3 years).The left side was affected in 13 cases and the right side in 6 ones.The angle of cubitus varus was 20.7°±2.8°.The lifting angle on the healthy side and the cubitus angle on the affected side were accurately measured on the Medical Image Archiving and Transmission System(PACS)to calculate the osteotomy angle.Lateral closed wedge osteotomy plus locking plating was conducted to correct the deformity via a small incision and posterior lateral approach.The lifting angle on the affected side was measured at the last follow-up.The Mayo elbow performance scores(MEPS)was used to evaluate the elbow function and the Bellemore scoring system the effects of elbow correction surgery.Results The 19 patients were followed up for 9 to 32 months(mean,14 months).A good healing was observed at the osteotomy site in all patients.At the last follow-up,the elbow lifting angle was 11.4°±1.6°and the surgical scars averaged 4 cm(from 3 to 5 cm).The cubitus varus was significantly improved after operation,leading to fine elbow function.According to the MEPS,10 cases were excellent,7 good and 2 moderate.According to the Bellemore scoring system,13 cases were excellent and 6 good.After operation,injury to partial ulnar nerve was observed in 2 cases and one patient developed mild elbow stiffness.Follow-ups revealed no implant failure like loosening or breakage and none cases of delayed fracture union or non-union.Conclusions The osteotomy angle should be accurately measured on the PACS before operation.Lateral closed wedge osteotomy plus locking plating should be performed via a small incision and posterior lateral approach.These procedures can ensure the orthopedic angle and postoperative recovery of the elbow joint,resulting in a limited surgical scar,beautiful appearance and fine efficacy.