成人创伤后肘内翻畸形的矫形及双柱固定

目的探讨肱骨髁上截骨双钢板固定治疗成人创伤后肘内翻的方法及疗效。方法回顾性分析2007年6月-2010年12月手术治疗22例成人创伤后肘内翻畸形患者的临床资料。其中男16例,女6例;年龄18～29岁,平均21岁。既往均有肱骨髁上骨折病史;初次骨折后3个月～1年,平均6个月出现肘内翻畸形;出现畸形后4～17年,平均8年入院手术。术前患侧肘关节提携角为肘内翻16～25°,平均20.6°。肘关节功能采用Flynn评分均为差。术中行肱骨外侧闭合楔形截骨,以2块重建钢板塑形后分别置于肱骨内外侧柱以固定截骨断端。术后无需外固定,早期行功能锻炼。结果术后切口均Ⅰ期愈合。22例均获随访,随访时间6～24个月,平均13个月。末次随访时患侧肘关节提携角为肘外翻0～10°,平均7.5°。患者截骨处均骨性愈合,愈合时间8～13周,平均10周。术后无感染,神经、血管损伤,内固定物松动、断裂等并发症发生,无肘内翻复发。末次随访时Flynn评分优17例,良3例,中2例,优良率91%。结论采用肱骨髁上截骨加双钢板固定治疗成人创伤后肘内翻畸形,固定坚强,骨折愈合率高,术后能早期功能锻炼,肘关节功能恢复满意。

Double volume internal fixation for correction of adult post-traumatic cubitus varus deformity

Objective Supracondylar closing wedge osteotomy is a standard operation for the management of post-traumatic cubitus varus deformity.There are many fixation methods for the broken ends of bone.However,most of these fixation methods are fraught with various complications.To evaluate the methods and functional results of double volume internal fixation for correction of adult post-traumatic cubitus varus deformity.Methods The clinical data were retrospectively reviewed,from 22 cases of adults post-traumatic cubitus varus deformity between June 2007 and December 2010.There were 16 males and 6 females,aged 18-29 years(mean,21 years) and they all had a history of supracondylar fracture.The deformities of cubitus varus appeared at 6 months(range,3 months to 1 year) after fracture,and the operations were carried out at 4-17 years(mean,8 years) after deformity occurrence.The valgus angle were 16-25°(mean,20.6°) and the Flynn functional scores were all poor before operation.Supracondylar closing wedge osteotomies were performed.Two reconstruction plates were moulded and placed to the media and lateral volumes of the humerus to fix the broken ends of the osteotomy surfaces.External fixation was not needed and early rehabilitation was performed postoperatively in all cases.Results Incisions healed by first intention.All cases were followed up 6 to 24 months(mean,13 months).At last follow-up,the valgus angle was 0-10°(mean,7.5°).All cases got bone union at 8-13 weeks(mean,10 weeks) after operation.No related complications occurred,such as infection,nervous or vein injury,and loosening or breakage of internal fixator;and no cubitus varus recurred.The Flynn scores were excellent in 17 cases,good in 3 cases,and fair in 2 cases;the excellent and good rate was 91%.Conclusion The operation of supracondylar osteotomy with double plates internal fixation for the correction of adult post-traumatic cubitus varus deformity can rigidly stabilize distal humerus,which is helpful to functional training just after operation and satisfactory restoration of the elbow function.