双平面截骨矫形并外侧解剖锁定板固定治疗成人肘内翻畸形  

Dual-planar osteotomy and lateral column anatomic locking plate fixation in the treatment of adult cubitus varus deformity

作　　者：张川 张作君 蔡鸿敏 昌中孝 杨林平 赵明 李星星 冯瑞萍 王国杰 段小波 

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)上肢损伤一科,河南洛阳471002

出　　处：《中国修复重建外科杂志》2017年第10期1173-1178,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南省科技攻关计划项目(152102310164)~~

摘　　要：目的探讨肱骨远端冠状面和矢状面双平面截骨矫形并外侧解剖锁定板固定治疗成人肘内翻畸形的疗效。方法回顾分析2012年4月—2014年9月采用肱骨远端冠状面和矢状面双平面截骨并外侧解剖锁定板固定治疗的6例成人肘内翻并肘关节屈曲受限患者临床资料。其中男3例,女3例;年龄18~35岁,平均22.2岁。均有明确儿童期肘关节骨折病史,受伤年龄为2~13岁,平均6.5岁。入院检查6例患者均无神经损伤、肘关节屈伸力量异常和不稳定等并发症。术前肘关节屈曲活动度(107.50±5.24)°,伸直活动度(–12.17±3.48)°;患侧提携角为(–19.50±4.46)°,健侧提携角为(11.50±2.67)°;患侧肱骨相对健侧短缩(0.42±0.38)cm。术后随访测量肘关节屈伸活动度、提携角、双侧肱骨短缩,采用去除双肘屈伸活动度对比的改良Laupattarakasem标准评定疗效。结果术后患者切口均Ⅰ期愈合,无术后早期并发症发生。6例患者均获随访,随访时间19~27个月,平均20.8个月。随访期间无内固定物松动断裂等并发症,骨折端均于术后3个月内获得骨性愈合。末次随访时肘关节屈曲活动度为(124.17±5.85)°,伸直活动度为(0.83±2.04)°,提携角为(12.00±4.19)°,肱骨短缩为(1.88±0.45)cm,均较术前显著改善(t=–6.742,P=0.001;t=–11.068,P=0.000;t=–20.400,P=0.000;t=–13.914,P=0.000)。按照改良Laupattarakasem标准评价,优1例,良4例,可1例,优良率83.3%。结论采用双平面截骨矫形可有效矫正肘内翻畸形并改善屈曲活动度,外侧解剖锁定板固定可满足术后早期活动的稳定要求。Objective To explore the effectiveness of distal humeral dual-planar osteotomy followed with distal humeral lateral column anotomical locking plate fixation in the treatment of adult cubitus varus deformity combined with flexion restriction. Methods The clinical data of 6 adult patients with cubitus varus deformity and flexion restriction treated with dual-planar osteotomy and internal fixation between April 2012 and September 2014 were reviewed. There were 3 males and 3 females with an average age of 22.2 years （range, 18-35 years）. All the patients had history of elbow injury in childhood, the age being injured was 6.5 years on average （range, 2-13 years）. There was no nerve injury, elbow strength weak, or unstable complications before admission. The preoperative elbow flexion was （107.50±5.24）°, elbow extension was （–12.17±3.48）°; the carring angle was （–19.50±4.46）°, the contralateral elbow carrying angle was （11.50±2.67）°; the length of humerus was （0.42±0.38） cm shorter than the unaffected humerus. The postoperative carrying angles, elbow flexion and extension, and humerus length were recorded. The modified Laupattarakasem criteria in which the comparison of bilateral elbow range of motion excluded was used to evaluate the results. Results Primary healing of incision was got in all patients and there was no early postoperative complications. All the patients were followed up 19-27 months （mean, 20.8 months）. During the follow-up, there was no complication such as loosening and breakage of the internal fixators and all fractures were healed within 3 months after operation. At last follow-up, the elbow flexion was （124.17±5.85）°, the elbow extension was （0.83±2.04）°, the carrying angle was （12.00±4.19）°, and the humerus shortening was （1.88±0.45） cm, all showing significant difference when compared with preoperative ones （t=–6.742, P=0.001; t=–11.068, P=0.000; t=–20.400, P=0.000; t=–13.914, P=0.000）. According to the modified Laup

关 键 词：肘内翻畸形 双平面截骨 内固定 

分 类 号：R687.4[医药卫生—骨科学]