肱骨外侧闭合楔形截骨联合外固定架治疗大龄儿童肘内翻畸形  

Lateral closing wedge osteotomy combined with external fixation for elbow varus deformity in adolescents

作　　者：胡超 李磊[1] 阳波[1] 王志强[1] HU Chao;LI Lei;YANG Bo;WANG Zhiqiang(Orthopedics Department,Suining Central Hospital,Suining 629000,Sichuan,China)

机构地区：[1]遂宁市中心医院骨科一病区,四川遂宁629000

出　　处：《中国现代手术学杂志》2023年第6期460-463,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较肱骨外侧闭合楔形截骨单边外固定架与锁定钢板治疗大龄儿童肘内翻畸形的疗效。方法回顾性分析2017年9月至2020年9月我院收治的36例儿童肘内翻畸形的临床资料,根据手术方法的不同分为单边外固定架组和锁定钢板组。单边外固定架组患侧提携角为-14.8°±3.2°;锁定钢板组患侧提携角为-15.9°±1.7°。术后1个月、2个月和6个月分别复查肘关节正侧位X线片,根据截骨端愈合情况决定是否取出外固定架或锁定钢板。根据Laupattarakasem功能评定标准,结合影像学结果对肘关节功能进行评定。结果和锁定钢板组相比,单边外固定架组手术时间更短[(50.6±5.5)min vs.(60.8±5.7)min],术中出血量更少[(25.3±2.8)mL vs.(40.6±3.9)mL],手术切口更小[(3.8±0.5)cm vs.(5.6±0.6)cm],差异均有统计学意义(P<0.05)。所有患者均获随访,随访时间为43(24~64)个月,36例患儿的截骨端均在术后6~8周获得骨性愈合。单边外固定架组出现钉道感染1例,锁定钢板组出现伤口感染1例,神经麻痹1例,差异无统计学差异(P>0.05)。两组患者术后提携角改变和Laupattarakasem功能评定差异均有统计学意义,单边外固定架组优良率更高(P<0.05)。结论作为大龄儿童肘内翻畸形肱骨外侧闭合楔形截骨后的固定方法之一,单边外固定架可以有效矫正畸形,具有操作简单、手术时间短、出血量少、创伤小等优点,值得在临床上推广应用。Objective To compare the efficacy between the unilateral external fixation and the locking plate fixation after lateral closing wedge osteotomy in the treatment of cubitus varus deformity in adolescents.Methods A retrospective case control study was carried out in 36 adolescents with cubitus varus deformity admitted to our hospital from September 2017 to September 2020.According to different surgical methods,they were divided into a unilateral external fixation group and a locking plate group.Among them,there were 18 cases in the unilateral external fixation group,with carrying angles of-14.8°±3.2°and 18 cases in the locking plate group,with carrying angles of-15.9°±1.7°.After 1 month,2 months,and 6 months of surgery,X-ray films of the elbow joint were re-examined in both the anterior and lateral directions.The decision to remove the external fixator or the locking plate was made based on the healing of the osteotomy site.According to the Laupatarakasem functional assessment criteria,elbow joint function was evaluated based on imaging results and elbow movements.Results Compared with the locking plate group,the unilateral external fixation group had a shorter surgical time[(50.6±5.5)min vs.(60.8±5.7)min],less intraoperative bleeding[(25.3±2.8)mL vs.(40.6±3.9)mL],and a smaller surgical incision[(3.8±0.5)cm vs.(5.6±0.6)cm],with statistically significant differences(P<0.05).All patients were followed up for 43(24~64)months,and the osteotomy ends of 36 patients achieved bone healing 6~8 weeks after surgery.There was 1 case of nail path infection in the unilateral external fixation group,1 case of wound infection and 1 case of nerve paralysis in the locking plate group,with no statistically significant difference(P>0.05).There was a significant difference in postoperative changes in carrying angle variety and Laupattarakasem functional as-sessment between the two groups.The unilateral external fixation group had a higher excellent rate(P<0.05).Conclusions As one of the fixation methods for the lateral clos

关 键 词：肘内翻 畸形 外侧楔形截骨术 外固定架 

分 类 号：R726.8[医药卫生—儿科]