外側閉合楔形截骨術矯正兒童創傷性肘內翻畸形_《中國修復重建外科雜志》

作者：

楊健 , 何濤貞 , 劉少鋒 , 彭明惺 , 劉敏

四川大學華西醫院小兒外科（成都，610041）;

關鍵詞：

創傷性肘內翻畸形外側閉合楔形截骨術兒童

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目的探討采用外側閉合楔形截骨術矯正兒童創傷性肘內翻畸形的療效。方法 1996 年7 月－2010 年6 月，收治兒童肱骨髁上骨折后肘內翻畸形20 例。男13 例，女7 例。年齡7 ～ 14 歲，平均10.6 歲。左側12 例，右側8 例。13 例曾于外院行閉合復位經皮克氏針內固定、石膏外固定，7 例誤診為關節脫位和軟組織損傷行石膏外固定。傷后2 ～ 12 年出現肘關節外觀異常和活動受限。術前肘關節活動范圍為屈100 ～ 150°，平均133.0°；伸0 ～ 24°，平均11.7°。肘內翻角度為20 ～ 50°，平均32.1°。均采用外側閉合楔形截骨術治療。結果術后切口均Ⅰ期愈合，無相關并發癥發生。17 例患兒獲隨訪，隨訪時間1 ～ 14 年，平均5 年。X 線片示截骨區均達骨性愈合，愈合時間為5 ～ 8 周，平均6 周。肘關節內翻畸形均獲矯正，末次隨訪時肘關節活動范圍為屈110 ～ 150°，平均135.9°；伸0 ～ 27°，平均12.9°。根據Jupiter 等肘關節評分系統評價肘關節功能，優14 例，良2 例，可1 例，優良率94.1%。1 例術后1 個月拔除克氏針后畸形復發，1 年后再次行外側閉合楔形截骨術矯正。結論外側閉合楔形截骨術具有操作簡便、手術并發癥少等優點，是治療兒童創傷性肘內翻畸形有效方法之一。

引用本文： 楊健,何濤貞,劉少鋒,彭明惺,劉敏. 外側閉合楔形截骨術矯正兒童創傷性肘內翻畸形. 中國修復重建外科雜志, 2012, 26(6): 657-660. doi: 復制

1.	潘少川. 實用小兒骨科學. 2版. 北京: 人民衛生出版社, 2005: 443-450.
2.	Storm SW, Williams DP, Khoury J, et al. Elbow deformities after fracture. Hand Clin, 2006, 22(1): 121-129.
3.	Murase T, Oka K, Moritomo H, et al. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg (Am), 2008, 90(11): 2375-2389.
4.	Husban FM, Odat MM, Dwiri MD. Lateral closing wedge supracondylar humeral osteotomy for treatment of post-traumatic cubitus varus. JRMS, 2010, 17(3): 33-38.
5.	Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
6.	Jupiter JB, Neff U, Holzach P, et al. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg (Am), 1985, 67(2): 226-239.
7.	嚴世貴, 潘志軍. 臨床小兒骨科學. 北京: 中國醫藥科技出版社, 2010: 115-118.
8.	郭躍明, 王志遠, 鄒勇根, 等. 肱骨髁上骨折并發肘內翻畸形病理形態學分析. 中國矯形外科雜志, 2004, 12(10): 725-727.
9.	Davids JR, Lamoreaux DC, Brooker RC, et al. Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop, 2011, 31(4): 353-365.
10.	Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
11.	張金哲, 潘少川, 黃澄如. 實用小兒外科學. 杭州: 浙江科學技術出版社, 2003: 1290-1300.
12.	Cho CH, Song KS, Min BW, et al. Long-term results of remodeling of lateral condylar prominence after lateral closed-wedge osteotomy for cubitus varus. J Shoulder Elbow Surg, 2009, 18(3): 478-483.
13.	張問廣, 胡月光. 肱骨髁上骨折并發肘內翻的臨床與應用解剖研究. 臨床小兒外科雜志, 2008, 7(3): 43-44.
14.	Buß FR, Schulz AP, Lill H, et al. Supracondylar osteotomies of posttraumatic distal humeral deformities in young adults——technique and results. Open Orthop J, 2011, 5: 389-394.
15.	Skaggs DL, Glassman D, Weiss JM, et al. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. Journal of Children’s Orthopaedics, 2011, 5(4): 305-312.
16.	Bali K, Sudesh P, Krishnan V, et al. Modified step-cut osteomy for post-traumatic cubitus varus: our experience with 14 children. Orthop Traumatol Surg Res, 2011, 97(7): 741-749.
17.	Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a teaching hospital. J Bone Joint Surg (Br), 2006, 88(3): 362-365.
18.	Feng C, Gou Y, Zhu Z, et al. Biomechanical analysis of supracondylar humerus fractures pinning for fractures with coronal lateral obliquity. J Pediatr Orthop, 2012, 32(2): 196-200.
19.	Srivastava AK, Srivastava D, Gaur S. Lateral close wedge osteotomy for cubitus varus deformity. Indian J Orthop, 2008, 42(4): 466-470.
20.	Hamdi A, Poitras P, Louati H, et al. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2010, 30(2): 135-139.
21.	Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
22.	Moon MS, Kim SS, Kim ST, et al. Lateral closing wedge osteotomy with or without medialisation of the distal fragment for cubitus varus. J Orthop Surg (Hong Kong), 2010, 18(2): 220-223.

1. 潘少川. 實用小兒骨科學. 2版. 北京: 人民衛生出版社, 2005: 443-450.
2. Storm SW, Williams DP, Khoury J, et al. Elbow deformities after fracture. Hand Clin, 2006, 22(1): 121-129.
3. Murase T, Oka K, Moritomo H, et al. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg (Am), 2008, 90(11): 2375-2389.
4. Husban FM, Odat MM, Dwiri MD. Lateral closing wedge supracondylar humeral osteotomy for treatment of post-traumatic cubitus varus. JRMS, 2010, 17(3): 33-38.
5. Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
6. Jupiter JB, Neff U, Holzach P, et al. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg (Am), 1985, 67(2): 226-239.
7. 嚴世貴, 潘志軍. 臨床小兒骨科學. 北京: 中國醫藥科技出版社, 2010: 115-118.
8. 郭躍明, 王志遠, 鄒勇根, 等. 肱骨髁上骨折并發肘內翻畸形病理形態學分析. 中國矯形外科雜志, 2004, 12(10): 725-727.
9. Davids JR, Lamoreaux DC, Brooker RC, et al. Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop, 2011, 31(4): 353-365.
10. Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
11. 張金哲, 潘少川, 黃澄如. 實用小兒外科學. 杭州: 浙江科學技術出版社, 2003: 1290-1300.
12. Cho CH, Song KS, Min BW, et al. Long-term results of remodeling of lateral condylar prominence after lateral closed-wedge osteotomy for cubitus varus. J Shoulder Elbow Surg, 2009, 18(3): 478-483.
13. 張問廣, 胡月光. 肱骨髁上骨折并發肘內翻的臨床與應用解剖研究. 臨床小兒外科雜志, 2008, 7(3): 43-44.
14. Buß FR, Schulz AP, Lill H, et al. Supracondylar osteotomies of posttraumatic distal humeral deformities in young adults——technique and results. Open Orthop J, 2011, 5: 389-394.
15. Skaggs DL, Glassman D, Weiss JM, et al. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. Journal of Children’s Orthopaedics, 2011, 5(4): 305-312.
16. Bali K, Sudesh P, Krishnan V, et al. Modified step-cut osteomy for post-traumatic cubitus varus: our experience with 14 children. Orthop Traumatol Surg Res, 2011, 97(7): 741-749.
17. Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a teaching hospital. J Bone Joint Surg (Br), 2006, 88(3): 362-365.
18. Feng C, Gou Y, Zhu Z, et al. Biomechanical analysis of supracondylar humerus fractures pinning for fractures with coronal lateral obliquity. J Pediatr Orthop, 2012, 32(2): 196-200.
19. Srivastava AK, Srivastava D, Gaur S. Lateral close wedge osteotomy for cubitus varus deformity. Indian J Orthop, 2008, 42(4): 466-470.
20. Hamdi A, Poitras P, Louati H, et al. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2010, 30(2): 135-139.
21. Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
22. Moon MS, Kim SS, Kim ST, et al. Lateral closing wedge osteotomy with or without medialisation of the distal fragment for cubitus varus. J Orthop Surg (Hong Kong), 2010, 18(2): 220-223.

《中國修復重建外科雜志》

外側閉合楔形截骨術矯正兒童創傷性肘內翻畸形

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《中國修復重建外科雜志》

外側閉合楔形截骨術矯正兒童創傷性肘內翻畸形

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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