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目的探讨肱骨髁上等腰三角形截骨的优点以及联合成人桡骨远端L形锁定钢板内固定治疗大龄儿童肘内翻的临床疗效。方法自2008-01—2013-01采用肱骨髁上等腰三角形截骨联合成人桡骨远端L形锁定钢板内固定治疗儿童肘内翻21例。截骨方式设计为肱骨髁上等腰三角形截骨,术前设计截骨图纸,依据截骨角度(截骨角度=健侧提携角+肘内翻角)计算等腰三角形截骨外侧底边的长度。结果本组手术时间20~35 min,平均24.5 min;术中失血量15~30 ml,平均25.3 ml。21例均获得随访28~60个月,平均36个月。疗效依据Flynn肘关节功能评分标准并综合屈伸功能评价:优18例,良2例,可1例,优良率95.2%。末次随访时提携角0°~13°(9.20±1.21)°,肘关节屈伸活动范围0°~130°。结论采用肱骨髁上等腰三角形截骨联合成人桡骨远端L形锁定钢板内固定治疗大龄儿童肘内翻出血量少,肘关节外侧骨突畸形改善明显,内固定确切,可有效防止截骨角度丢失,并有利于肘关节早期功能锻炼,关节功能恢复满意。
Objective To investigate the clinical advantages of supracondylar humeral triangle osteotomy and the combined adult L-shaped distal locking plate internal fixation for the treatment of elbow varus in older children. Methods Twenty - one children with cubitus varus were treated with supracondylar humeral triangle osteotomy and adult distal radius L - shaped plate fixation from January 2008 to January 2013. The osteotomy was designed as an isosceles triangular triangle osteotomy on the humeral condyle. The osteotomy design was preoperatively designed to calculate the lateral base of the lateral side of the isosceles triangle based on the osteotomy angle (osteotomy angle = contralateral + angulation) length. Results The operation time of this group was 20-35 minutes (average 24.5 minutes). The intraoperative blood loss was 15-30 ml (average 25.3 ml). All 21 patients were followed up for 28 to 60 months with an average of 36 months. Efficacy based on Flynn elbow joint function evaluation criteria and comprehensive flexion and extension function evaluation: excellent in 18 cases, good in 2 cases, fair in 1 case, good rate of 95.2%. At the last follow-up, the carrying angle was 0 ° ~ 13 ° (9.20 ± 1.21 ° °) and the elbow flexion and extension range was 0 ° ~ 130 °. Conclusions The use of humeral supracondylam triangle osteotomy combined with adult distal radius L-shaped plate fixation for elder children with less cubitus varus bleeding, significant improvement of the lateral deformity of the elbow, internal fixation, and can effectively prevent the osteotomy angle Lost, and is conducive to early functional exercise elbow, joint function recovery satisfaction.