基于健侧的计算机模拟截骨联合导板技术治疗青少年肘内翻畸形

Computer-simulated osteotomy based on health-side combined with guide plate technique in treatment of cubitus varus deformity in adolescents

目的 探讨基于健侧的计算机模拟截骨联合导板技术治疗青少年肘内翻畸形的可行性及早期临床疗效。方法 回顾分析2019年6月—2023年2月收治且符合选择标准的23例肘内翻畸形患者临床资料。其中男17例,女6例;年龄4~16岁,平均8.5岁。受伤至手术时间1~4年。使用低辐射剂量CT一次性扫描患者双上肢数据,以肱骨头后倾角定义肱骨远端旋转角度,术前患侧肱骨远端旋转(33.82±4.39)°。将CT平扫数据导入9yuan3D数字骨科系统(V3.34)软件,重建双上肢三维图像,以健侧上肢为参考行模拟手术,规划最佳截骨方案,重叠比对,制备截骨导板。术后定期随访,复查X线片观察截骨区骨痂形成情况;手术前后于X线片及CT图像上测量患者双上肢提携角(肘外翻角度为正值,肘内翻角度为负值)、前倾角,同时测量肘关节屈伸活动度及上肢外旋活动度,采用Mayo评分评价肘关节功能。结果 手术时间34~46 min,平均39 min。所有患者均获随访,随访时间5~26个月,平均14.9个月。术后切口均Ⅰ期愈合;2例患者克氏针固定术后出现钉道刺激症状,经换药后好转;定期复查X线片均未发生内固定器械断裂、松动等并发症。术后4周截骨端有连续性骨痂形成,8~12周截骨端愈合。末次随访时,患侧提携角、前倾角、上肢外旋活动度及肘关节伸直、屈曲活动度均较术前显著改善(P<0.05);与健侧比较除肘关节伸直活动度差异有统计学意义(P<0.05)外,其余指标健患侧比较差异均无统计学意义(P>0.05)。末次随访时,Mayo肘关节评分为85~100分,平均99.3分;获优22例、良1例,优良率100%。结论 基于健侧的计算机模拟截骨联合导板技术治疗青少年肘内翻畸形可实现精准截骨,具有手术时间短、易操作等优势,早期临床效果满意。

Objective To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents.Methods The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed.There were 17 males and 6 females,ranging in age from 4 to 16 years with an average of 8.5 years.The time from injury to operation was 1-4 years.The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient’s upper extremity data at one time,and the preoperative rotation of the distal humerus on the affected side was(33.82±4.39)°.The CT plain scan data were imported into 9yuan3D digital orthopaedic system(V3.34 software)to reconstruct three-dimensional images of both upper extremities.The simulated operation was performed with the healthy upper extremity as the reference,the best osteotomy scheme was planned,overlapped and compared,and the osteotomy guide plate was prepared.The patients were followed up regularly after operation,and the formation of callus in the osteotomy area was observed by X-ray examination.Before and after operation,the carrying angle of both upper extremities(the angle of cubitus valgus was positive,and the angle of cubitus varus was negative)and anteversion angle were measured on X-ray and CT images.At the same time,the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured,and Mayo score was used to evaluate the function of elbow joint.Results The operation time ranged from 34 to 46 minutes,with an average of 39 minutes.All patients were followed up 5-26 months,with a mean of 14.9 months.All the incisions healed by first intention after the operation;2 patients had nail path irritation symptoms after Kirschner wire fixation,which improved after dressing change;no complication such as breakage and loosening of internal fixators occurred after regular X-ray review.Continuous callus formed at the osteotomy end at 4 weeks after operation,and the osteotomy end healed at 8-12 weeks after operation.At last follow-up,the carrying angle,anteversion angle,external rotation range of motion,and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones(P<0.05).Except for the extension range of motion of the healthy elbow joint(P<0.05),there was no significant difference in other indicators between the two sides(P>0.05).At last follow-up,the Mayo elbow score was 85-100,with an average of 99.3;22 cases were excellent,1 case was good,and the excellent and good rate was 100%.Conclusion Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy,which has the advantages of short operation time and easy operation,and the short-term effectiveness is satisfactory.