微创截骨钢缆接骨术治疗儿童肘内翻畸形

Minimally invasive osteotomy and cable osteosynthesis for treatment of adolescent cubitus varus

目的探讨应用微创截骨钢缆接骨术治疗儿童肘内翻畸形的可行性与有效性。方法自2004年3月至2007年10月对11例儿童（10～14岁，平均12．9岁）肘内翻患者（其中2例同时存在10°内旋）进行微创肱骨髁上楔形截骨，保留对侧骨皮质与骨膜的完整，在骨折上下端钻人2枚螺丝钉，调整旋转角度，螺钉间用钢缆进行接骨固定，术后石膏固定2周后行功能操练。结果11例患儿骨折全部愈合，愈合时间30～45d，平均36．3d，无一例感染与神经损伤发生；术前肘关节内翻角度35°±5°，肘关节功能：屈曲125°±10°，伸直10°±5°。所有患者获得20～42个月（平均33．5个月）随访，术后肘关节外翻角度8°±2°，与术前相比，差异有统计学意义（t=16．632，P〈0．05）；肘关节屈曲130°±8°，伸直8°±3°，与术前相比，差异均无统计学意义（P〉0．05），2例术前伴有内旋患者术后内旋得到改善。结论采用微创截骨钢缆接骨术的方法对儿童肘内翻进行治疗，具有骨膜剥离少、骨折端稳定、骨折俞合快的优势，并可以改善旋转畸形，对肘关节伸屈功能无明显影响。

Objective To explore the possibility and effectiveness of minimally invasive osteotnmy and cable osteosynthesis for the treatment of adolescent cubitus varus. Methods Eleven cases of adolescent cubitus varus （2 cases complicated with internal rotation of 10°） were treated with minimally invasive supracondylar wedged osteotomy to preserve the integrity of the eontralateral cortex and periosteum. Two screws were inserted above and below the fracture line. They were fixed with cable after the greenstick fracture and internal rotation were adjusted. Plastic bandage was applied for 1 week postoperatively before rehabilitation. Results Bone fi＇actures healed in the 11 cases in 36.3 days averagely, without infection or nerve palsy. Before operation, the mean angles of varus, flexion and extension were 35°± 5°, 125° ± 10° and 10° ± 5°respectively. After a mean follow-up of 33.5 months, the mean valgus angle of the elbow was improved to 8°±2°（t=16.632, P 〈0.05）, flexion to 130°±8°and extension to 8°±3°（P〉 0.05）. Intemalrotation deformity was also ameliorated in the 2 cases. Conclusion It is practical and effective to treat adolescent cubitus varus with minimally invasive osteotomy and cable osteosynthesis, for it can lead to stable fixation, short healing timc, and does not affect the flexion and extension of the elbow joint.