Ilizarov技术治疗陈旧性桡骨小头脱位

EFFECTIVENESS OF Ilizarov TECHNIQUE IN TREATMENT OF OLD DISLOCATION OF RADIAL HEAD

目的 探讨应用改良Ilizarov半环形外固定架结合尺骨微创截骨延长成角治疗儿童陈旧性桡骨小头脱位的临床疗效。方法 2012年3月-2015年1月,应用改良Ilizarov半环形外固定架结合尺骨微创截骨治疗儿童陈旧性桡骨小头脱位14例。男12例,女2例;年龄2~13岁,平均7.2岁。先天性桡骨小头脱位1例,陈旧性孟氏骨折13例。Bado分型：Ⅰ型12例,Ⅲ型2例。比较手术前后肘关节伸屈及前臂旋前、旋后活动度;应用肘关节Mackay等功能评定标准评价疗效。结果 手术时间50~65 min,平均58 min。患儿均获随访,随访时间6~33个月,平均21个月。均无切口、钉道感染和骨化性肌炎、桡骨小头再脱位发生。X线片复查示,尺骨截骨区均骨性愈合,愈合时间82~114 d,平均90 d;肱桡关系佳。肘关节伸屈和前臂旋前、旋后活动度均较术前明显改善,比较差异有统计学意义（P〈0.05）。末次随访时,根据Mackay等功能评定标准进行疗效评价：获优12例,良2例。结论改良Ilizarov半环形外固定架结合尺骨微创截骨治疗儿童陈旧性桡骨小头脱位,具有创伤小、去架方便、复位满意和有效避免尺骨截骨后骨不连等优点,远期疗效有待进一步随访。

Objective To explore the effectiveness of modified Ilizarov semi-ring external fixator combined with an ulnar osteotomy lengthening in the treatment of old dislocation of the radial head in children. Methods A retrospective analysis was made on the data of 14 patients with old dislocation of the radial head treated by the modified Ilizarov semi-ring external fixator combined with ulnar osteotomy lengthening between March 2012 and January 2015. The age ranged from 2 to 13 years （mean, 7.2 years）, including 12 boys and 2 girls. There was 1 case of congential dislocation of the radial head and 13 cases of old Monteggia fracture. According to the Bado＇s classification, dislocation was rated as grade I in 12 cases and grade III in 2 cases. The elbow flexion-extension and forearm pronation and supination were compared between at pre- and post-operation; Mackay evaluation standard of elbow joint function was used to evaluate the effectiveness. Results The operation time ranged from 50 to 65 minutes （mean, 58 minutes）. All patients were followed up 6-33 months （mean, 21 months）. No complication of infection, myositis ossiflcans, or redislocation occurred. X-ray film showed bony healing at ulnar osteotomy site within 82-114 days （mean, 90 days）. The elbow flexion-extension and forearm pronation and supination were significantly improved at postoperation when compared with preoperation （P〈0.05）. The results of Mackay function assessment were excellent in 12 cases and good in 2 cases. ConcIusion The modified IIizarov semi-ring external fixator combined with an ulnar osteotomy lengthening has the advantages of small incision, easy removal of fixator, satisfactory reduction, and no nonunion at ulnar osteotomy site in the treatment of old dislocation of the radial head, but the long-term effectiveness still needs to be followed up.