改良肱骨髁上阶梯截骨技术治疗儿童肘内翻畸形  

Modified humeral supracondylar step -cut osteotomy for cubitus varus in children

作　　者：王儒法[1] 楼跃[1] 唐凯[1] 汪飞[1] 江波[1] 刘高鹏 陈铭超 林刚[1] Wang Rufa;Lou Yue;Tang Kai;Wang Fei;Jiang Bo;Liu Gaopeng;Chen Mingchao;Lin Gang(Department of Pediatric Orthopaedics,Children's Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院骨科,210008

出　　处：《中华实用儿科临床杂志》2018年第23期1788-1791,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨应用改良肱骨髁上阶梯截骨(M-HSSCO)技术治疗儿童肘内翻畸形的可行性及临床疗效.方法 回顾性分析2016年6月至2017年6月南京医科大学附属儿童医院收治的25例肘内翻患儿资料,其中男20例,女5例;年龄6~11岁[(8.5 ± 0.3)岁].术中使用M-HSSCO技术进行截骨矫形,肱骨鹰嘴窝近端0.5~1.0 cm处L形截骨,外侧保留三角骨块,近端截骨线同样为L形截骨,外侧去除三角骨块,以内侧骨皮质和骨膜作为旋转支点,双L形截骨面抱紧闭合.采用Bellemore评价系统评价截骨矫形术后,患侧提携角与健侧提携角的差异,术后肘关节屈伸活动角度与术前肘关节屈伸活动角度的差异,以及有无残余内翻畸形和需要手术处理的并发症.结果 患儿术后均获得随访,随访时间6~18个月,平均12个月.术前患侧提携角-(15°~30°)[-(22.20 ± 1.40)°],术后5°~10°[(7.60 ± 0. 47)°],末次随访5°~9°[(7.30 ± 0.40)°],术后的提携角较术前有明显改善,差异有统计学意义(t=23. 34,P=0.000).末次随访的提携角较术前有明显改善,差异有统计学意义(t=23.14,P=0.000).术前肘关节活动范围-5° ~130°[(132.5 ± 0.5)°],术后0° ~125°[(123.6 ± 1.4)°],末次随访0°~130°[(126.8 ± 1. 3)°],至末次随访时,无明显矫正丢失,与术后及术前相比,差异均无统计学意义(均P>0.05).评估结果:优92.0%(23/25例)、良18.0%(2/25例)、差0(0/25例).术中、术后均未出现神经损伤、关节不稳、再骨折及内固定失败等并发症,切口均一期愈合,无感染发生.结论 对儿童肘内翻畸形的患儿采用M-HSSCO技术进行截骨矫形可行性较高,并可以取得较好的疗效.Objective To investigate the feasibility and clinical effectiveness of modified humeral supracondy-lar step-cut osteotomy(M-HSSCO)for cubitus varus in children.Methods Between June 2016 and June 2017,the study included 25 children (20 boys and 5 girls)presenting cubitus varus at the age of (8.5 ± 0.3)years old (6-11 years old)in the Children's Hospital of Nanjing Medical University.M-HSSCO was used in the osteotomy operation. The initial osteotomy was performed as a right triangle osteotomy.The inferior margin of this right triangle was outlined parallel to the joint line 0.5-1.0 cm above the olecranon fossa.Then,they were incised from the medial end of this parallel line,which made an angle between the first and second lines equal to the desired corrective humerus elbow-wrist angle.Next,from the lateral end of the second line,the third line perpendicular to the first line was cut.Finally, desired right triangle was outlined and removed.The second right triangle osteotomy from proximal line of osteotomy was similar as the above.The medial cortex and periosteum was used as a hinge and rotated to make two osteotomy parts combined steadily.The Bellemore evaluation system was used to evaluate the difference in carrying angle degree be-tween the affected side and normal side after osteotomy,and the different degree of flexion and extension in the elbow joint between preoperation and post-operation.Residual varus deformity and other complications were also evaluated. Results All patients were followed up for 6-18 months (mean 12 months).The preoperative ipsilateral carrying an-gle was-(15°-30°)[-(22.20 ± 1.40)°],the postoperative was 5°-10°[(7. 60 ± 0.47)°]and the final follow-up was 5°-9°[(7.30 ± 0.40)°].There were statistically significant differences in the flexion angles before surgery and after surgery (t=23.34,P=0.000).There were statistically significant differences in the flexion angles before surgery and at final follow-up (t=23.14,P=0.000).The mean range of joint motion of the elbow was -5°-130�

关 键 词：肘内翻 阶梯截骨术 儿童 

分 类 号：R726.8[医药卫生—儿科]