改良外侧楔形截骨术治疗肘内翻畸形

Treatment of modified lateral wedge osteotomy for cubitus varus deformity with sagittal deformity

目的探讨改良外侧楔形截骨术(两刀一次成型截骨)治疗肘内翻合并矢状位畸形的临床效果.方法收集收治肘内翻合并矢状位畸形患者,观察采用改良外侧楔形截骨法(两刀一次成型截骨)后的临床疗效.共收集22例患者,男17例,女5例;年龄4~30岁,平均(11.15±9.63)岁.连续跟踪随访15~47个月,平均(30.47±7.99)个月.测评术前术后的X线片,包括手术前后肘关节提携角及肘关节活动度等,采用Flynn肘关节评分表评估矫形效果.结果完成全部系统随访评估患者20例,男15例,女5例.患者影像学表现、外观形态和功能活动均获得显著改善,提携角由术前的(-17.65±3.01)°增加至术后的(6.95±1.39)°(P<0.01),肘关节活动度由术前的(109.35±5.73)°增至术后(130.05±4.07)°(P<0.01).根据Flynn肘关节功能评定标准,20例患者中,19例优秀,1例良好.没有患者出现切口感染和内固定失效.结论改良外侧楔形截骨法(两刀一次成型截骨)能有效的矫正青少年肘内翻合并矢状位畸形,增加肘关节活动度,该手术具有操作简单、伤口小、恢复快等优点.

Objective To evaluate the effectiveness of modified lateral wedge osteotomy(two-osteotomy in one-shot)in the treatment of cubitus varus deformity with sagittal deformity.Methods Twenty two children with elbow varus were retrospectively studied in department of orthopedics.There were 17 males and 5 females with an average age of 11.15 years old.The anterior posterior and lateral position X ray films of elbows were carried out.All patients were followed up from 15 to 47 months(means 30.47±7.99 months).The postoperative elbow lifting angle and elbow mobility were measured,and the Flynn elbow score table was applied to evaluate the correction.Results The final included patients were 20 patients,with 15 males and 5 females.All patients had significant improvement in radiographic and cosmetic function,with the carrying angle increasing from-17.65±3.01°preoperatively to 6.95±1.39°postoperatively(P<0.01),and the elbow range of motion increasing from 109.35±5.73°preoperatively to 130.05±4.07°postoperatively(P<0.01).According to the Flynn elbow function assessment criteria,among the 20 patients,19 were excellent and 1 was good.There was no wound infection or instrumentation failure.Conclusion Modified French osteotomy(two-osteotomy in one-shot)can effectively correct cubitus varus combined with sagittal deformity in adolescents and increase the range of motion of the elbow joint.