肱骨髁上楔形截骨克氏针内固定矫正肱骨髁上骨折并发肘内翻畸形24例

Supracondylar Wedge Osteotomy Kirschner Needle Internal Fixation to Correct Humeral Supracondylar Fracture Complicated with Elbow Varus Deformity in 24 Cases

目的:探讨肱骨髁上楔形截骨克氏针内固定矫正肱骨髁上骨折并发肘内翻畸形的临床疗效。方法:回顾性分析2014年12月—2019年12月于江西中医药大学附属医院儿童骨科采用肱骨髁上楔形截骨克氏针内固定矫正肱骨髁上骨折并发肘内翻畸形病例24例。测量手术前后提携角及肘关节屈伸活动度,拆除内固定后3个月采用Mayo肘关节功能评分标准评定肘关节功能。结果:24例患儿均获随访,术前提携角为(-15.23±4.21)°,术后提携角为(10.34±3.12)°,平均改变25°,经配对样本t检验,差异有统计学意义(P<0.05);术前肘关节伸直和屈曲活动分别为(-0.35±3.05)°、(112.54±15.78)°,术后肘关节伸直和屈曲活动分别为(0.06±1.02)°、(141.65±7.48)°,肘关节伸直活动差异无统计学意义(P>0.05),肘关节屈曲活动差异具有统计学意义(P<0.05)。内固定拆除3个月后,按照Mayo肘关节功能评分标准评定肘关节功能,其中优15例、良6例、中3例。结论:肱骨髁上楔形截骨克氏针内固定是矫正肱骨髁上骨折并发肘内翻畸形的有效方法。

Objective:To investigate the clinical effect of humeral supracondylar wedge osteotomy and Kirschner wire internal fixation in the correction of humeral supracondylar fracture with cubitus varus deformity.Methods:From December 2014 to December 2019,24cases of humeral supracondylar fracture complicated with cubitus varus deformity were retrospectively analyzed in Children’s Orthopedics Department of Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine.The lifting angle and elbow flexion and extension range of motion were measured before and after operation.The elbow function was evaluated with Mayo elbow function scoring standard 3 months after removal of internal fixation.Results:All 24 children were followed up.The average preoperative carrying angle was(-15.23±4.21)°,and the average postoperative carrying angle was(10.34±3.12)°,with an average change of 25°.The difference was statistically significant(P<0.05)by paired sample t-test;The average elbow extension and flexion activities before operation were(-0.35±3.05)°and(112.54±15.78)°,respectively.The average elbow extension and flexion activities after operation were(0.06±1.02)°and(141.65±7.48)°.There was no significant difference in elbow extension activities(P>0.05),but there was significant difference in elbow flexion activities(P<0.05).Three months after the removal of internal fixation,the elbow function was evaluated according to the Mayo elbow function scoring standard,including excellent 15 cases,good 6 cases and fair 3 cases.Conclusion:Wedge osteotomy and Kirschner wire internal fixation is an effective method to correct cubitus varus deformity in supracondylar fracture of humerus.