尺骨截骨钢板内固定治疗儿童陈旧性桡骨头前脱位

Ulnar osteotomy and internal fixation for old anterior dislocation of radial head in children

目的:探讨尺骨截骨内固定手术治疗儿童桡骨头陈旧性前脱位的临床疗效。方法:2004年1月至2010年1月,采用切开复位桡骨头、尺骨上段截骨内固定治疗18例陈旧性桡骨头前脱位患者。其中男12例,女6例;年龄3～15岁,平均(6.9±1.3)岁;受伤至手术时间为5～65个月,平均(24.0±5.5)个月。所有患者术前均有肘关节屈伸活动和前臂旋转活动受限,但均无桡神经损伤,桡骨头无明显变形。结果:所有患者伤口均Ⅰ期愈合,未发生骨不连、桡骨头再脱位及神经损伤等并发症。所有患者均获随访,时间9～38个月,平均(17.0±4.5)个月;骨折愈合时间2.3～3.9个月,平均(2.8±0.5)个月。术后肘关节屈曲活动及前臂的旋转活动较术前明显改善。根据朱玉奎等评定标准,优14例,良3例,可1例。结论:尺骨截骨内固定治疗儿童陈旧性桡骨头前脱位疗效满意,可以有效地改善肘关节屈伸及前臂旋转的功能,防止桡骨头再次脱位。

Objective：To evaluate the clinical results of ulnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children.Methods：From Jan.2004 to Jan.2010,18 patients with old anterior dislocation of radial head were treated with open reduction for radial head and ulnar osteotomy and internal fixation,including 12 males and 6 females with an average age of（6.9±1.3） years（3 to 15 years）.Among them,15 cases had history of external injury,from injury to operation was for 5-65 months with an average of（24.0±5.5） months.Limitation of activity occurred in all patients including flexion and extension of elbow joint and rotation of forearm,without radial nerve injury and obviously radial head deformation.Results：All incisions obtained primary healing and no nonunion,re-dislocation of radial head and nerve injury were found.All patients were followed up from 9 to 38 months with an average of（17.0±4.5） months.Union time of fracture was from 2.3 to 3.9 months with an average of（2.8±0.5） months.Postoperative activity in flexion and extension of elbow joint and rotation of forearm improved significantly compared with preoperative.The clinical effects were evaluated according to Zhuyukui criteria,14 patients got excellent results,3 good,1 fair.Conclusion：Ulnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children can obtain satisfactory results and effectively improve the activities in flexion and extension of elbow joint and rotation of forearm and prevent re-dislocation of radial head.