外侧闭合楔形截骨术矫正儿童创伤性肘内翻畸形  

LATERAL CLOSING WEDGE OSTEOTOMY FOR TREATMENT OF TRAUMATIC CUBITUS VARUS DEFORMITY IN CHILDREN

作　　者：杨健[1] 何涛贞[1] 刘少锋[1] 彭明惺[1] 刘敏[1] 

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《中国修复重建外科杂志》2012年第6期657-660,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用外侧闭合楔形截骨术矫正儿童创伤性肘内翻畸形的疗效。方法 1996年7月-2010年6月,收治儿童肱骨髁上骨折后肘内翻畸形20例。男13例,女7例。年龄7～14岁,平均10.6岁。左侧12例,右侧8例。13例曾于外院行闭合复位经皮克氏针内固定、石膏外固定,7例误诊为关节脱位和软组织损伤行石膏外固定。伤后2～12年出现肘关节外观异常和活动受限。术前肘关节活动范围为屈100～150°,平均133.0°;伸0～24°,平均11.7°。肘内翻角度为20～50°,平均32.1°。均采用外侧闭合楔形截骨术治疗。结果术后切口均Ⅰ期愈合,无相关并发症发生。17例患儿获随访,随访时间1～14年,平均5年。X线片示截骨区均达骨性愈合,愈合时间为5～8周,平均6周。肘关节内翻畸形均获矫正,末次随访时肘关节活动范围为屈110～150°,平均135.9°;伸0～27°,平均12.9°。根据Jupiter等肘关节评分系统评价肘关节功能,优14例,良2例,可1例,优良率94.1%。1例术后1个月拔除克氏针后畸形复发,1年后再次行外侧闭合楔形截骨术矫正。结论外侧闭合楔形截骨术具有操作简便、手术并发症少等优点,是治疗儿童创伤性肘内翻畸形有效方法之一。Objective To investigate the e ectiveness of lateral closing wedge osteotomy for treatment of traumatic cubitus varus deformity in children.Methods Between July 1996 and June 2010,20 cases of traumatic cubitus varus deformity after humeral supracondylar fracture were treated by lateral closing wedge osteotomy.There were 13 boys and 7 girls,aged from 7 to 14 years（mean,10.6 years）.The left elbow was involved in 12 cases and right elbow in 8 cases.Thirteen cases had received closed reduction,percutaneous Kirschner wire xation,and external xation in other hospital,and 7 cases misdiagnosed as elbow luxation and soft tissue injury had given external xation.Cubitus varus deformity occurred at 2-12 years after injury.Preoperatively,the elbow range of motion（ROM） in exion and extension was 100-150°（mean,133.0°） and 0-24°（mean,11.7°）,respectively.The angle of cubitus varus deformity was 20-50°（mean,32.1°）.Results All incisions healed by rst intention,and no related complication occurred.A total of 17 patients were followed up 1-14 years（mean,5 years）.X-ray lms revealed that bone union was achieved in all cases within 5-8 weeks after operation（mean,6 weeks）.The deformity of cubitus varus was corrected in all cases.At last follow-up,the elbow ROM in exion and extension was 110-150°（mean,135.9°） and 0-27°（mean,12.9°）,respectively.According to Jupiter et al.elbow score system,the results were excellent in 14 cases,good in 2 cases,and fair in 1 case;the excellent and good rate was 94.1%.One patient underwent recurrence at 1 month after removal of the Kirschner wire,and lateral closing wedge osteotomy was performed again after 1 year.Conclusion Lateral closing wedge osteotomy is a safe and e ective surgical procedure in correcting traumatic cubitus varus deformity in children,which is easy to operate and can be e ective in reducing the complications.

关 键 词：创伤性肘内翻畸形 外侧闭合楔形截骨术 儿童 

分 类 号：R726.8[医药卫生—儿科]