外伤性肘关节外翻畸形

TraumaticCubitusValgusDeformity

１９６３～１９９５年我所共收治外伤性肘关节外翻畸形３０例。肘部损伤时年龄２～２１岁，平均８．１岁，其中儿童２８例，占９３．３％。肘部损伤为肱骨外髁骨折１９例，肱骨髁上骨折８例，肱骨内髁骨折１例，桡骨头脱位２例。肘关节提携角２０°～４５°，平均２８．７°。合并创伤性尺神经炎２２例，肘关节创伤性关节炎１１例。２２例创伤性尺神经炎均做了神经松解前移术，其中２０例平均随访６年４个月，优良率为８５％。７例做肱骨髁上截骨术，平均随访７年１１月，肘关节外观及功能满意。作者认为，肘部损伤（尤其是儿童肘部损伤）的延误诊治、复位固定不良和骨骺损伤是发生肘外翻的原因。早期诊断、及时准确复位和确切固定是减少肘外翻发生的重要措施。严重肘外翻畸形可做肱骨髁上截骨矫正，合并创伤性尺神经炎应早期做尺神经松解前移术。

From1963to1995,30patientswithtraumaticcubitusvalgusdeformityweretreated.Theageofthepatientsrangedfrom2to21years(mean8.1years)atthetimeofinjury.Ofthem,28(93.3%)wereyoungerthan14years.Theinjurieswerefracturesofthelateralcondyleofthehumerusin19,supracondylarfracturesofthehumerusin8,fractureofthemedialcondyleofthehumerusinoneanddislocationsoftheradialheadin2.Thecarryingangleoftheelbowrangedfrom20°to45°,withanaverageof28.7°.Thecomplicationsincludedtraumaticulnarneuritisin22andtraumaticarthritisoftheelbowin11.Neurolysisandanteriortranspositionofunlarnervewereperformedin22patientswhohadthetraumaticulnarneuritis.Twentyofthemhadexcelentandgoodrateof85%inanaverageof6yearsand4monthsoffolowed-up.Supracondylarosteotomyofthehumerusweredonein7patientsforcorectionofcubitusvalgus.Alhadsatisfactoryfunctionandgoodappearanceoftheelbowwithanav-erageof7yearsand11monthsoffolow-up.Theauthorsconcludethatthedelayeddiagnosis,incorrectreductionandfixationaswelasepiphysisinjuryarethemaincausesforcubitusvalgusdeformityfol-lowingelbowtraumaespecialyinchildren.Itisstressedthattheelbowtraumashouldbeearlydiag-nosed,accuratelyreducedandfirmlyimmobilizedinordertopreventcubitusvalgusdeformity.Supra-condylarosteotomyandneurolysiswithanteriortranspositionofunlarnervemaybethechoicesofthetreatmentforcubitusvalgusdeformityandtraumaticulnarneuritis.