改良阶梯式截骨法矫正儿童创伤后肘内翻畸形

目的:探讨采用肱骨髁上改良阶梯式截骨联合钢板等内固定治疗儿童肘内翻畸形的临床疗效。方法:回顾性研究我科自2012年1月~2014年12月收治的14例肘内翻畸形患者,其中,男10例/女4例,年龄6~14岁,平均10.3岁,右侧9例/左侧5例。所有病例均有明确的伸直型肱骨髁上骨折病史,在创伤后约1.7年(1~4.5年)行改良阶梯式截骨。通过测量手术前后提携角及肘关节活动度,并依据Flynn临床肘关节功能评定标准对患肢功能进行评价。结果:本组患者术后均获得随访,随访时间12~26个月,平均17.4±2.7个月,肱骨截骨处达到骨性愈合的时间为2.5~4个月(平均2.9±0.6个月),术后畸形矫正良好,获得5.2±1.7°提携角。术后关节活动范围-0.7±1.6~134.5±2.4°,与术前相比,伸展活动的差异无统计学意义(t=0.871,P0.05);而屈曲活动改善明显,差异有统计学意义(t=18.819,P0.01)。末次随访时截骨纠正角度丢失1.4±0.8°。根据Flynn肘关节功能评定标准:优11例/良2例/可1例,优良率92.86%。均无感染、外髁突出、过度肥厚增生的术后瘢痕、血管神经损伤、关节不稳等并发症。结论:本研究针对创伤后儿童肘内翻畸形的手术疗效进行随访,发现改良阶梯式截骨的手术操作相对简单,矫形效果满意,能早期恢复肘关节功能且畸形复发率低,是一种美容效果较好的治疗肘内翻的截骨方式。

Modified Step-cut Osteotomy for Post-traumatic Cubitus Varus in Children

ABSTRACT Objective: To investigate the clinical effectiveness of modified step-cut osteotomy for post-traumatic cubitus varus in children. Methods: Fourteen children (10 boys and 4 girls) presenting a mal-united extension type supracondylar fracture of the humerus with an average age of 10.3 years (6-14 years) were operated around 1.7 years (1-4.5 years) after the injury using a modified step-cut osteotomy. Objective assessment included measurement of preoperative and postoperative carrying angle and range of elbow motion. Results were graded excellent, good or poor as per the Flynn criteria. Results: A total of 14 patients were followed up 12-26 months (mean, 17.4±2.7 months). X-ray films revealed that bone union was achieved in all cases within 2.5-4 months after operation (mean, 2.9±0.6 months). The deformity of cubitus varus was corrected in all cases, and the postoperative carrying angle was 5.2±1.7 °. The mean range of motion was -1.7 ±2.3 °/117.9 ±3.8 ° (extension/flexion) before surgery and -0.7±1.6 °/134.5±2.4 ° at final follow-up. There were statistically significant differences between the flexion angles before surgery and at final follow-up (paired t-test). The carrying angle reduced by 1.4±0.8 °in 2 cases (1 ° , 3 ° ) at follow-up. The Flynn criteria of elbow function showed excellent in 11 cases, good in 2 cases and effective in 1 case, the excellent rate was 92.86 %. There were no cases with postoperative infection, lateral prominence, hypertrophic scar, vascular and neural injury, instabilities or any significant postoperative complications. Conclusion: Via follow-up, it is discovered that, the modified step-cut osteotomy is a safe and simple procedure which prevents lateral prominence and leads to good or excellent outcomes in most of the patients. Therefore, we recommend this modified step-cut osteotomy as an effective osteotomy, characterized by good cosmetic result, to treat cubitus varus in children.