闭合楔形截骨后远端骨块内移锁定钢板内固定治疗儿童肘内翻畸形  

Distal bone mass medial transposition and locking plate internal fixation following closed wedge osteotomy for treatment of cubitus varus deformity in children

作　　者：赵仁欢 刘昕[1] 邓志强[1] 叶家军[1] 康持 ZHAO Ren-huan;LIU Xin;DENG Zhi-qiang;YE Jia-jun;KANG Chi(Dept of Pediatric Orthopaedics,Sichuan Province Orthopedic Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]四川省骨科医院儿童骨科,四川成都610041

出　　处：《临床骨科杂志》2024年第5期680-684,共5页Journal of Clinical Orthopaedics

基　　金：四川省中医药管理局科学技术研究专项基金(编号:2020LC0182)。

摘　　要：目的 探讨闭合楔形截骨后远端骨块内移锁定钢板内固定治疗儿童肘内翻畸形的疗效。方法 将70例肘内翻畸形患儿按手术方法不同分为观察组(采用肱骨远端外侧闭合楔形截骨后远端骨块内移锁定钢板内固定治疗,40例)和对照组(采用肱骨远端外侧闭合楔形截骨后外翻截骨端矫正克氏针内固定治疗,30例)。记录截骨端愈合时间,比较两组提携角、肘关节活动度、肘外侧突出指数(LCPI)、肘关节外观。结果 患儿均获得随访,时间12~18(14.46±6.71)个月。截骨端均愈合,时间4~6(4.46±1.31)周。两组提携角、LCPI术后12个月均优于术前(P<0.05)。术后12个月,LCPI观察组小于对照组(P<0.05);提携角、肘关节活动度及前臂活动度两组比较差异均无统计学意义(P>0.05)。末次随访时,两组患儿肘内翻畸形均得到明显改善,肘关节活动无明显受限;对照组肘关节凸起明显而影响外观,观察组肘关节无明显凸起,外观满意。结论 肱骨远端外侧闭合楔形截骨后远端骨块内移锁定钢板内固定能有效治疗儿童肘内翻畸形,且能避免肘外侧凸起,是一种简单有效的手术方法。Objective To investigate the therapeutic effect of distal bone mass medial transposition and locking plate internal fixation after closed wedge osteotomy for the treatment of cubitus varus deformity in children.Methods The 70 children with cubitus varus deformities were divided into the observation group(40 cases were treated with distal humeral lateral closed wedge osteotomy followed by distal bone mass medial transposition and locking plate internal fixation)and the control group(30 cases were treated with distal humeral lateral closed wedge osteotomy followed by external inversion osteotomy correction and Kirschner wire internal fixation),according to different surgical methods.The healing time of the osteotomy site was recorded;and the lifting angle,elbow joint range of motion,lateral elbow protrusion index(LCPI),and elbow joint appearance were compared between the two groups.Results All patients were followed up for 12~18(14.46±6.71)months.All osteotomy ends healed within 4~6(4.46±1.31)weeks.The lifting angles and LCPI:at 12 months after surgery,two groups were better than before surgery(P<0.05);and LCPI of observation group was smaller than the control group(P<0.05);there were no statistical difference between the two groups in terms of lifting angle,elbow joint range of motion and forearm range of motion(P>0.05).At the last follow-up,both groups of children showed significant improvement in cubitus varus deformity and no significant limitation in elbow joint movement;while the control group had significant elbow joint protrusions that affected the appearance,while the observation group had no significant elbow joint protrusions and the appearance was satisfactory.Conclusions Distal humerus lateral closed wedge osteotomy followed by medial transposition of the distal bone mass and locking plate internal fixation can effectively treat cubitus varus deformity in children,and which can avoid lateral protrusion of the elbow,it is a simple and effective surgical method.

关 键 词：肘内翻 闭合楔形截骨 远端内移 儿童 

分 类 号：R726.825[医药卫生—儿科] R726.873[医药卫生—临床医学]