尺骨近端截骨治疗少年陈旧性单纯桡骨头脱位

Surgical treatment of chronic isolated radial head dislocation in children with proximal nlnar osteotomy

目的 评估采用尺骨近端截骨治疗少年陈旧性单纯桡骨头脱位的临床疗效。方法 回顾性研究了采用尺骨近端截骨治疗陈旧性单纯桡骨头脱位的6例患者，手术时的年龄从7～12岁，从受伤到接受手术治疗的时间间隔为6个月～4年，平均为[（19．3±16．5）个月，^x±s，下同]，其中2例患者同时缝合了环状韧带，1例患者进行了桡侧侧副韧带的重建。重点分析了术后功能恢复情况和术前、术后的影像学改变。结果 本组6例术后随访时间平均为（16．5±8．7）个月。所有患者截骨部位均达骨性愈合，无异位骨化或其他较为严重的并发症，也无肘关节疼痛和桡骨头再脱位。肘关节屈伸活动度为（140．0±7．1）°，前臂旋转活动度为（129．0±18．4）°，患侧握力占健侧握力的百分比为（96．9±3．5）％。术后影像学提示随着随访时间的延长，尺骨的再塑形非常明显，表现为截骨所致的向后成角逐渐圆滑，最终成角消失，以及损伤所致的“尺骨弓征”逐渐纠正。结论 对于少年陈旧性单纯桡骨头脱位如果无明显桡骨头畸形，采用尺骨近端截骨治疗可以取得较为满意的疗效。

Objective To evaluate the clinical results of proximal ulnar osteotomy for treatment of chronic isolated radial head dislocation in children. Methods Six cases of chronic isolated radial head dislocation treated by proximal ulnar osteotomy were studied retrospectively for their surgical results. The age of the patients ranged from 7 to 12 years old. The intervals between injury and treatment were between 6 months and 4 years （average 19.3±16.5 months）. Two patients had annular ligament repair in addition to osteotomy, while another patient had radial lateral collateral ligament reconstnction at the same time. The functional status as well as the image changes were evaluated. Results The average follow-up time for these patients was 16.5±8.7 months. All patients got bony healing at the site of osteotomy. No heterotopic ossification and other severe complications were found. Also there was no elbow pain or recurrent dislocation of the radial head. The mean flexion and extension range of motion of the elbow joint wes 140.0°±7.1°. The mean rotation range of motion for the forearm wes 129.0°±18.4°. The mean pementago of grip strength for injured side versus the contralateral side was 96.9% ± 3.5%. The X-ray films showed that there was an obvious remodeling procedure for the ulna. Both the angulation of the osteotomy and the ulnar bow sign were gradually corrected with growth. Conclusion Proximal ulnar osteotomy can lead to satisfactory results for chronic isolated radial head dislocation in children in case there is no obvious radial head dofonnity.