肱骨髁上楔形截骨联合改良张力带钢丝治疗肘内翻

Humeral supracondylar wedge osteotomy combined with modified tension band wire in treatment of cubitus varus

目的:探讨应用肱骨髁上楔形截骨矫形联合改良张力带钢丝内固定治疗肘内翻畸形的可行性与临床疗效。方法:选取自贡市第一人民医院2015年1月至2019年1月共37例肘内翻畸形患者,男21例,女16例;平均年龄(12.9±2.1)岁;有10例合并内旋畸形。采用肱骨髁上楔形截骨联合改良张力带钢丝进行治疗。采用配对设计资料t检验比较患侧肘关节术前及术后的内翻角、屈曲活动及伸直活动度;采用成组设计资料t检验比较患侧及健侧肘关节的提携角、屈曲活动及伸直活动度。结果:所有患者均得到随访,平均(2.0±0.8)年;截骨均全部愈合,完全愈合时间平均(74±10)d。术后患侧肘关节内翻畸形均明显矫正(t=19.749,P<0.05);患侧肘关节屈曲活动、伸直活动度与术前比较改善(t=3.279、-10.573,均为P<0.05);术后患侧肘关节提携角、屈曲活动及伸直活动度与健侧比较无差异(均为P>0.05)。所有患者术后切口均一期愈合,无感染、神经损伤发生,无内固定松动、脱落及断裂等并发症发生。结论:肱骨髁上楔形截骨矫形联合改良张力带钢丝内固定治疗肘内翻畸形,具有术中操作简便,内翻畸形矫正明显,内固定强度可靠,可早期功能锻炼,术后肘关节功能恢复好等优点。

Objective To investigate the clinical effectiveness of humeral supracondylar wedge osteotomy combined with modified tension band wire to treat cubitus varus.Methods Thirty-seven patients with cubitus varus in the First Peoples Hospital of Zigong from January 2015 to January 2019 were chosen,21 males and 16 females,the age were(12.9±2.1)years on average.Among them,10 cases were complicated with internal rotation.All the patients were treated by humeral supracondylar wedge osteotomy combined with modified tension band wire.The results of varus angle,flexion activity and extension activity of the elbow joint were compared between pre-operation and post-operation by paired t test.The results of carrying angle,flexion activity and extension activity of elbow joint were compared between affected side and normal side by group design t test.Results All the patients were followed up for(2.0±0.8)years on average.The bone osteotomy of all the patients healed completely.The complete healing time was(74±10)d on average.The varus deformity of elbow joint on the affected side was corrected after the operation(t=19.749,P<0.05).The flexion activity and extension activity of the affected side was improved compared with those pre-operation(t=3.279,-10.573,both P<0.05).There was no significant difference in the carrying angle,flexion activity and extension activity of elbow between affected side and normal side(all P>0.05).The incisions of all the patients healed in the primary stage,without infection,nerve injury,internal fixation loosening,falling off or breakage.Conclusion Humeral supracondylar wedge osteotomy combined with modified tension band wire has the advantages of simple operation,obvious correction of varus deformity,reliable strength of internal fixation,early functional exercise and good recovery of elbow function for treatment of cubitus varus.