肱骨外髁骨折后骨不连并肘外翻畸形的手术治疗  

TREATMENT OF NONUNION OF LATERAL HUMERAL CONDYLE FRACTURE COMBINED WITH CUBITUS VALGUS

作　　者：苏琦[1] 陈芒[2] 周敏[1] 廖春来[1] 蔡俊东 

机构地区：[1]解放军第188医院创伤骨科,广东潮州521000 [2]解放军第188医院骨关节科,广东潮州521000

出　　处：《中国修复重建外科杂志》2014年第4期406-409,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨肱骨外髁骨折后骨不连并肘外翻畸形的手术方法及疗效。方法 2006年1月-2011年9月,收治19例肱骨外髁骨折后骨不连并肘外翻畸形患者。男11例,女8例;年龄14～28岁,平均21.6岁。左侧7例,右侧12例。受伤至该次入院时间3～22年,平均9年。患者肘外侧均可见骨性突出、外髁膨大,伴外翻畸形;与健侧相比,提携角增大（34.00±7.68）°。2例关节僵硬,余17例肘关节屈伸活动度（117.35±19.77）°,其中10例屈伸活动度受限。3例伴尺神经炎表现。采用肱骨髁上内侧闭合楔形截骨、肱骨外髁复位截骨块植骨内固定术治疗。结果 术后患者切口均Ⅰ期愈合,无相关并发症发生。19例均获随访,随访时间2～6年,平均3.2年。X线片复查示,截骨及骨折均在6个月内达骨性愈合。3例伴尺神经炎者术后神经损伤症状均在6个月内消失。末次随访时,患侧提携角较健侧增大（3.21±4.09）°,与术前比较差异有统计学意义（t=30.472,P=0.000）;2例术前肘关节僵硬者关节活动度分别达20°和30°,余17例肘关节屈伸活动度为（117.64±15.72）°,与术前比较差异无统计学意义（t=—0.180,P=0.859）;根据肘关节外观、活动功能及并发症情况评定疗效,获优9例,良8例,差2例,优良率为89.5%。结论 对于肱骨外髁骨折后骨不连并肘外翻畸形,通过肱骨髁上内侧闭合楔形截骨能有效纠正肘外翻畸形、改善尺神经炎症状;肱骨外髁复位截骨块植骨内固定能有效稳定骨折端,促进愈合,并获得较好疗效。Objective To investigate the surgical procedures and results of nonunion of lateral humeral condyle fracture combined with cubitus valgus. Methods Between January 2006 and September 2011, 19 cases of nonunion of lateral humeral condyle fracture combined with cubitus valgus were treated with supracondylar closing wedge osteotomy, open reduction, autogenous bone grafting, and internal fixation. There were 11 males and 8 females, aged 14-28 years （mean, 21.6 years）. The left side was involved in 7 cases, and the right side in 12 cases. The disease duration was 3-22 years （mean, 9 years）. The osseous protuberance and enlargement were seen in the lateral condyle of all the cases, with cubitus valgus. Compared with the contralateral side, the angle of cubitus valgus deformity increased （34.00 ＋ 7.68）~ at the affected side. The elbow range of motion of flexion and extension was （117.35 _＋ 19.77）~ in the other 17 patients except 2 patients with joint stiff. Among them, 10 patients had limited mobility. Three patients had ulnar neuritis. Results All the patients obtained primary healing of incision, and no surgery-related complication occurred. Nineteen patients were followed up 2-6 years （mean, 3.2 years）. Bony union at lateral condylar fracture site and the supracondylar osteotomy site was achieved in all cases within 6 months postoperatively. In 3 patients with ulnar neuritis, the symptoms of nerve injury disappeared within 6 months. At last follow- up, the angle of cubitus valgus deformity increased （3.21 _＋ 4.09）~ at the affected side when compared with the contralateral side, showing significant difference when compared with preoperative angle （t=30.472, P=0.000）. The range of motion of the elbow was 20~ and 30~ in 2 patients with joint stiff before operation; the elbow range of motion of flexion and extension was （117.64 _＋ 15.72）~ in the other 17 patients, showing no significant difference when compared with preoperative value （~ -0.180, P=0.859）. According to the appear

关 键 词：肱骨外髁骨折 骨不连 肘外翻畸形 

分 类 号：R726.8[医药卫生—儿科]