肱骨远端倒“V”形截骨治疗儿童肘内翻的疗效评价

Distal humerus inverted ＂V＂-shaped osteotomy for children＇ s cubitus varus deformity.

目的介绍肱骨远端倒“V”形截骨治疗儿童肘内翻畸形的手术操作技术，并评价其近期疗效。方法2009年1月至2011年7月作者收治10例儿童肘内翻患儿，术前依照x线片测量肘内翻的严重程度，确定需要外翻截骨的角度，在肱骨远端实施倒“V”形截骨，实现所需矫正的角度为内翻角＋7°的正常提携角后，采取交叉克氏针固定，屈肘60°位石膏固定，6周后拆石膏并拔除克氏针，开始主动肘关节功能训练。采用临床外观、肘关节伸屈功能，x线片测量提携角的方法评价治疗结果。结果10例均获得随访，平均随访时间1．8年（1—2．5年）。患肢提携角接近正常，肘关节伸屈活动达到术前水平，无切口感染、血管神经损伤、矫形丢失、骨不愈合等并发症。术后平均10周截骨处均达骨性愈合。临床评价和x线评价结果均达到优良的标准。结论肱骨远端倒“V”形截骨治疗儿童肘内翻畸形，手术操作相对简单，矫形效果好，能有效恢复肱骨与尺骨的解剖轴线。

Objective This paper is to introduce the surgical techniques for the distal humerus inverted ＂V＂-shaped osteotomy for cubitus varus deformity in children, and to evaluate its preliminary efficacy. Methods The surgical procedures employ the distal humerus inverted ＂V＂-shaped osteotomy to treat children＇ s cubitus varus deformity. Its first-stage surgery achieved a satisfactory correction location through intersecting kirschner fixation and plaster fixation in elbow flexion 60° for six weeks. An active elbow joint functional exercise was carried out after the demolition of plaster and the pullout of kirschner 6 weeks later. The surgery evaluates the therapeutic results, through clinical appearance, joint function, and X-ray measurement for the carrying angles. Results All of 10 cases were casually visited and the patients were followed after osteotomy for an average time of 1.8 years （1 - 2.5 years）. None of the complications were happened like wound infection, neurovascular injury, orthopedic loss, nonunion and so on. The results demonstrate that the reunion of osteotomy is in the average of 10 weeks and the recovery of morphological appearance and function of the limbs are satisfactory. The results of the clinical evaluation and X-ray evaluation are excellent. Conclusion It can be concluded that the surgical procedures in the distal humerus inverted ＂V＂-shaped osteotomy for children＇ s cubitus varus deformity is relatively simple, reliable in orthopaedic, and effective for the recovery of mechanical axis near the elbow joints. The sugery is a good choice for the treatment of children＇ s cubitus varus deformity, and therefore can be widely applied.