儿童肘内翻髁上截骨矫正外固定与内固定比较  

Comparison of external versus internal fixations of supracondylar osteotomy for correction of cubitus varus deformity in children

作　　者：谭为 朱嘉文 孙永建 吴伟平 付博文 刘钱珍 黄文华 TAN Wei;ZHU Jia-wen;SUN Yong-jian;WU Wei-ping;FU Bo-wen;LIU Qian-zhen;HUANG Wen-hua(Department of Pediatric Orthopedics,Center for Orthopaedic Surgery,The Third Affiliated Hospital of Southern Medical University,Guangzhou 510665,China;Graduate School,Guangdong Medical University,Zhanjiang 524023,China;School of Basic Medical Sciences,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学第三附属医院骨科医学中心儿童骨科,广东广州510665 [2]广东医科大学研究生学院,广东湛江524023 [3]南方医科大学基础医学院,广东广州510515

出　　处：《中国矫形外科杂志》2021年第22期2017-2021,共5页Orthopedic Journal of China

基　　金：国家重点研发计划项目(编号:2017YFC1103400)。

摘　　要：[目的]比较肘内翻肱骨髁上截骨矫形外固定与内固定的临床效果。[方法]回顾性分析2013年1月-2019年12月本院手术治疗的肘内翻患儿75例。依据术前医患沟通结果,将患儿分为两组,47例采用截骨外固定架固定治疗,28例采用截骨钢板内固定治疗。比较两组围手术期、随访与影像资料。[结果]两组均顺利手术,术中均无血管神经损伤。外固定组在手术时间、术中出血量、手术切口长度均显著优于内固定组(P<0.05)。两组患儿恢复肘关节完全负重活动时间的差异无统计学意义(P>0.05)。随术后时间推移,两组患儿肘伸屈ROM和前臂旋转ROM均显著增加(P<0.05),相应时间点,两组间肘伸屈ROM和前臂旋转ROM的差异均无统计学意义(P>0.05)。末次随访按Bellemore标准评估临床效果,外固定组,优43例,良4例,优良率为91.49%;内固定组,优25例,良3例,优良率为89.29%。影像方面,与术前相比,两组患儿末次随访时肱骨前倾角和提携角均显著增加(P<0.05),相应时间点,两组间肱骨前倾角和提携角的差异均无统计学意义(P>0.05),两组截骨愈合时间的差异无统计学意义(P>0.05)。[结论]肘内翻矫形截骨术后采用外固定具有手术时间短、切口小的优势,较内固定更具优越性。[Objective]To compare the clinical outcomes of external fixator versus internal fixations with plate of supracondylar osteotomy for correction of cubitus varus deformity in children.[Methods]A retrospective study was done on 75 children who received surgical correction of cubitus varus deformity in our hospital from January 2013 to December 2019.According to preoperative doctor-patient communication,47 children had osteotomy fixed with external fixator(EF),while the other 28 patients underwent internal fixation of the osteotomy with plate(IF).The perioperative,follow-up and imaging data were compared between the two groups.[Results]All children in both groups were operated on smoothly,without vascular and nerve injury during the operation.The EF group was significantly superior to the IF group in terms of operation time,intraoperative blood loss,and surgical incision length(P<0.05).There was no significant difference in the time to recover the full weight-bearing activity between the two groups(P>0.05).The elbow extension-flexion range of motion(ROM)and the forearm rotation ROM increased significantly in both groups over time postoperatively(P<0.05),however,there was no statistically significant difference in ROMs between the two groups at any corresponding time point(P>0.05).At the latest follow-up,the clinical results were graded as excellent in 43 cases and good in 4,with excellent rate of 91.49%in the EF group,whereas excellent in 25 cases and good in 3,with excellent rate of 89.29%in the IF group according to Bellemorecriteria.In terms of imaging assessment,the humerus antever-sion angle and the carrying angle significantly increased in both groups at the latest follow-up compared with those preoperatively(P<0.05),nevertheless there were no statistically significant differences in the radiographic measurements between the two groups at any corresponding time point.In addition,there was no a significant difference in the healing time of osteotomy between the two groups(P>0.05).[Conclusion]The EF takes advanta

关 键 词：肘内翻 肱骨髁上截骨 外固定架 钢板内固定 

分 类 号：R687[医药卫生—骨科学]