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目的探讨采用外侧闭合楔形截骨术矫正儿童创伤性肘内翻畸形的疗效。方法 1996年7月-2010年6月,收治儿童肱骨髁上骨折后肘内翻畸形20例。男13例,女7例。年龄7～14岁,平均10.6岁。左侧12例,右侧8例。13例曾于外院行闭合复位经皮克氏针内固定、石膏外固定,7例误诊为关节脱位和软组织损伤行石膏外固定。伤后2～12年出现肘关节外观异常和活动受限。术前肘关节活动范围为屈100～150°,平均133.0°;伸0～24°,平均11.7°。肘内翻角度为20～50°,平均32.1°。均采用外侧闭合楔形截骨术治疗。结果术后切口均Ⅰ期愈合,无相关并发症发生。17例患儿获随访,随访时间1～14年,平均5年。X线片示截骨区均达骨性愈合,愈合时间为5～8周,平均6周。肘关节内翻畸形均获矫正,末次随访时肘关节活动范围为屈110～150°,平均135.9°;伸0～27°,平均12.9°。根据Jupiter等肘关节评分系统评价肘关节功能,优14例,良2例,可1例,优良率94.1%。1例术后1个月拔除克氏针后畸形复发,1年后再次行外侧闭合楔形截骨术矫正。结论外侧闭合楔形截骨术具有操作简便、手术并发症少等优点,是治疗儿童创伤性肘内翻畸形有效方法之一。
Objective To investigate the curative effect of lateral closed wedge osteotomy on the treatment of traumatic cubitus varus deformity in children. Methods From July 1996 to June 2010, 20 children with cubitus varus deformity underwent supracondylar fractures of the humerus. 13 males and 7 females. Aged 7 to 14 years old, with an average of 10.6 years old. Left in 12 cases, right in 8 cases. Thirteen patients who had underwent closed reduction and percutaneous Kirschner wire fixation and external fixation with plaster were treated in the external hospital. Seven cases were misdiagnosed as gypsum external fixation with dislocation of the joint and soft tissue injury. 2 to 12 years after injury, the elbow appears abnormal and limited activity. Preoperative elbow range of flexion 100 ~ 150 °, an average of 133.0 °; extended 0 ~ 24 °, an average of 11.7 °. Elbow valgus angle of 20 ~ 50 °, an average of 32.1 °. Lateral closed wedge osteotomy were used. Results The incisions healed in the first stage without any complication. Seventeen children were followed up for 1 to 14 years with an average of 5 years. X-ray film showed osteotomy bone healing, healing time is 5 to 8 weeks, an average of 6 weeks. Elbow varus deformity was corrected, the elbow range of last visit was flexion 110 ~ 150 °, an average of 135.9 °; extended 0 ~ 27 °, an average of 12.9 °. The elbow joint function was evaluated according to Jupiter et al., 14 cases were excellent, 2 good and 1 fair. The excellent and good rate was 94.1%. One case had a recurrence of deformity after removal of Kirschner wire one month after surgery. One year later, the lateral closed wedge osteotomy was performed again. Conclusions The lateral closed wedge osteotomy has many advantages, such as simple operation, fewer complications and so on. It is an effective method to treat traumatic cubitus varus deformity in children.