肱骨髁上截骨联合外固定支架辅助复位固定治疗儿童肘内翻20例

Treatment of cubitus varus in children with external fixation assisted restoration and fixation after supracondylar osteotomy of humerus

目的探讨肱骨髁上截骨联合外固定支架辅助复位固定治疗儿童肘内翻的临床方法及效果。方法回顾性分析2018年5月-2019年5月采用肘关节外侧小切口,肱骨髁上楔形截骨联合外固定支架骨钉作为操作杆进行复位固定,治疗20例儿童肘内翻的临床资料。术后均采用肘关节功能位石膏托固定,4周后拆除石膏进行功能训练。结果所有患儿术后随访2~3年,截骨部位均于术后6~8周骨性愈合,术后2~3个月肘关节屈伸活动范围恢复正常。术后提携角由术前平均内翻30°恢复至术后平均外翻10°,肘内翻畸形无复发。结论肱骨髁上楔形截骨术后,在截骨平面的远近端采用外固定支架的骨钉作为操作杆进行复位固定,治疗儿童肘内翻,具有切口小、操作简单、截骨角度准确、复位简单等优点,同时可一次性矫正尺偏、过伸、旋转畸形,固定牢固。该手术方法可以实现患儿早期的肘关节功能训练,加快关节活动度的恢复。

Objective To explore the clinical application and efficacy of external fixator assisted reduction and fixation of humeral supracondylar osteotomy in the treatment of cubitus varus in children.Methods The clinical data of 20 children with cubitus varus were analyzed retrospectively from May 2018 to may 2019.The operations were performed with small incisions on the lateral side of the elbow joint,wedge-shaped osteotomy of the supracondyle of the humerus,and using the pin of external fixator as an operating rod for reduction and fixation.The functional position of the elbow joint was fixed with a plaster cast after the operation,and the plaster was removed 4 weeks after functional exercise.Results All patients were followed up for 2-3 years after the operation.Bony union was obtained at the osteotomy site 6-10 weeks after the operation,and the range of elbow flexion and extension activities returned to normal 2-3 months after the operation.The postoperative lifting angle recovered from an average of 30°preoperative varus to an average of 10°postoperative valgus.There was no recurrence of cubitus varus deformity.Conclusion After the supracondylar wedge osteotomy of the humerus,the pin of the external fixation is used as the operating rod for the reduction of the distal and proximal ends of the osteotomy plane.This operation has the advantages of small incision,simple operation,accurate osteotomy angle,simple reduction,etc,and it can correct ulnar deviation,hyperextension,rotational deformity,and firm fixation simultaneously.Children can obtain the early functional exercise of the elbow joint and shorten the time to restore the joint range of motion.