肱骨髁上外侧楔形截骨联合锁定钢板内固定治疗儿童肘内翻畸形的疗效研究

Outcomes of supracondylar lateral closing wedge osteotomy plus locking plate fixation for post-traumatic cubitus varus in children

目的探究肱骨髁上外侧楔形截骨联合锁定钢板固定治疗儿童肘内翻畸形的疗效。方法回顾性分析上海交通大学医学院附属新华医院2012—2014年行肱骨外侧楔形截骨并行锁定钢板固定治疗28例肘内翻患儿的临床资料。其中男童23例,女童5例;左侧19例,右侧9例;手术平均年龄为7. 5岁(2～12岁);受伤至手术的平均时间为2. 6年(1～7年)。分别测量术前和术后的提携角、Baumann角、肱骨外侧髁突出指数(LCPI)、肘关节活动度。结果 28例患儿均获得完整随访,随访时间平均为30个月(24～48个月)。术前提携角平均为(-16. 81±12. 44)°,Baumann角平均为(9. 0±5. 44)°,截止最后一次随访时提携角和Baumann角平均为(9. 2±3. 58)°和(20±4. 65)°,差异有统计学意义(P <0. 001)。LCPI由术前(23. 7±6. 87)%降至(15. 23±3. 01)%,差异有统计学意义(t=2. 85,P=0. 008)。术前肘关节屈曲平均为(102. 14±2. 93)°,最后一次随访时肘关节伸屈曲平均为(131. 61±7. 58)°,差异有统计学意义(t=-12. 19,P <0. 001)。内固定平均取出时间为8. 32个月(5～14个月)。1例出现肘关节过伸约5°。无骨化性肌炎、血管神经损伤及感染、再骨折等并发症发生。结论肱骨外侧行楔形截骨并行锁定钢板内固定治疗肘内翻是一种可靠、有效、安全的方法,可以取得良好的截骨矫形效果。

Objective To evaluate the radiographic and clinical outcomes of supracondylar lateral closing wedge osteotomy with locking angular plate for post-traumatic cubitus varus in children.Methods Retrospective reviews were conducted for 28 children undergoing supracondylar lateral closing-wedge osteotomy for cubitus varus deformity between 2012 and 2014.There were 23 boys and 5 girls with a mean age of 7.5(2-12)years.The sideness was left(n=19)and right(n=9).The parameters of carrying angle,Baumann angle,lateral condylar prominence index(LCPI)and range of motion of elbow in flexion and extension(rom)were measured at preoperation and the last follow-up.Results The mean follow-up period was 30(24-48)months.The average preoperative value of carrying angle,Baumann angle and LCPI was(-16.81±12.44)°and(9.0±5.44)°and(23.7±6.87)%respectively.At the final follow-up,mean carrying angle,Baumann angle and LCPI of affected elbow were(9.2±3.58)°,(20±4.65)°and(15.23±3.01)%respectively.Mean carrying angle and mean Baumann angle were significantly corrected(P<0.05).Mean LCPI significantly decreased from 23.7%to 15.23%and mean ROM of elbow in flexion increased from 102.14°to 131.61°respectively(P<0.001).Mean time to remove plate was 8.32(5-14)months.Only one case had an over-flexion of elbow with 5°.There was no onset of myositis ossificans,vascular damage,infection or re-fracture.Conclusion Supracondylar lateral closing wedge osteotomy with locking angular plate is reliable,effective and safe for correcting varus deformity in children with lower complication rate.