肱骨远端等腰三角形截骨术治疗儿童肘内翻的临床应用

发布时间：2018-05-30 12:33

本文选题：肘内翻 + 等腰三角形截骨　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的肘内翻畸形(Cubitus varus,CV),是指肘关节正常的携带角消失,前臂向内发生旋转,从而产生了肘关节外观和正常解剖关系的改变。目前儿童肘内翻的治疗方案众多,主要体现在肱骨截骨方式的多样性。目前主要的截骨方式有肱骨远端楔形截骨、梯形截骨、弧顶状截骨等。各种方法虽然优点显著,但也存在明显的缺点,最常见的不足表现为肱骨远端截骨后外侧骨性的凸起所导致外观缺陷、手术设计复杂、操作困难无法普及等,针对以上不足,我们设计出等腰三角形截骨矫形术,该种方法理论上可以较好地弥补传统截骨方式的不足,所以本文将探讨应用肱骨远端等腰三角形截骨术治疗儿童肘内翻的适宜性及优缺点。方法选取2010年2月1日至2013年12月31日在本院诊断为肘内翻畸形患儿25例,其中男性患儿15例,女性患儿10例,患儿年龄区间为5~12岁,平均年龄9.5岁。手术方法均为采用肱骨远端等腰三角形截骨术,内固定均选择克氏针固定。所有患儿术前均进行患侧与健侧的肘关节正侧位X线检查,并测量患侧内翻角与健侧的提携角,根据患侧的内翻角与健侧的提携角计算出截骨三角块顶角的角度,从而设计截骨线。术中均采用外侧小切口入路,暴露肱骨远端鹰嘴窝及冠状窝顶点,根据术前设计的等腰三角形截骨角度及截骨线进行肱骨截骨,尺侧皮质不用锯断,起到铰链的作用,主刀固定肱骨近端,在助手帮助下将前臂向外侧外展,闭合截骨面后再利用预先留置的克氏针进行内固定,术后石膏固定3-4周。结果25例均获得随访,随访时间6~32月,平均16个月,术后病例无明显切口感染病例,出现3例针道轻微感染,换药后自愈,无骨愈合延迟;未发生尺神经炎病例;所有患儿肘内翻畸形外观均得到了矫正,符合生理,肘部无疼痛病例,肘关节功能均达到优良。结论肱骨远端等腰三角形楔形截骨术对于矫正儿童肘内翻畸形是一个非常实用、有效、可靠、安全、简单的方案,可以有效的解决外侧髁骨性突起和截骨处不稳定的问题,本方法并发症少,术后外形美观,功能良好,是值得推广的一种手术方案。
[Abstract]:Objective cubital varus is a cubital joint whose normal carrying angle disappears and the forearm rotates inward, which results in the appearance and normal anatomic relationship of the elbow. At present, there are many treatments for cubitus varus in children, mainly reflected in the diversity of humeral osteotomy. At present, the main osteotomy methods are wedge-shaped distal humerus osteotomy, trapezoid osteotomy, arcuate osteotomy and so on. Although the advantages of various methods are significant, they also have obvious shortcomings. The most common shortcomings are the appearance defects caused by the protrusions of the posterolateral bone of distal humeral osteotomy, the complexity of the operation design, the difficulty of operation, and so on. We designed the isosceles triangle osteotomy orthopedics, this method can make up the deficiency of the traditional osteotomy in theory, so this article will discuss the appropriateness, advantage and disadvantage of using the distal humerus triangle osteotomy to treat the cubitus varus in children. Methods from February 1, 2010 to December 31, 2013, 25 cases of cubitus varus malformation were diagnosed in our hospital. Among them, 15 cases were male and 10 cases were female. The age range of the children was 512 years old with an average age of 9.5 years. All the surgical methods were performed by isosceles triangle osteotomy of distal humerus, and Kirschner's needle was used for internal fixation. All the children were examined by X ray before operation, and the angle of the angle between the affected side and the healthy side was measured. According to the angle of the affected side and the healthy side, the angle of the apex angle of the osteotomy triangle block was calculated according to the angle of the side of the affected side and the healthy side of the elbow joint, and the angle of the angle was calculated according to the angle of the affected side and the healthy side. Thus the osteotomy line is designed. The lateral small incision approach was used to expose the vertices of the olecranon fossa and the coronal fossa of the distal humerus. According to the angle and line of isosceles triangle osteotomy designed before operation, humerus osteotomy was carried out, and the ulnar cortex did not need to be sawed. The proximal humerus was fixed with the main knife and the forearm was outreaching with the help of assistant. After closing the osteotomy surface, the internal fixation was performed with pre-indwelling Kirschner needle, and the plaster fixation was done for 3-4 weeks after operation. Results all the 25 cases were followed up for 632 months (mean 16 months). There were no obvious incision infection cases, 3 cases had slight infection of needle path, no bone union was delayed and no ulnar neuritis occurred. The appearance of cubitus varus deformity was corrected in all children, and the function of elbow joint was excellent. Conclusion the isosceles triangle wedge osteotomy of distal humerus is a practical, effective, reliable, safe and simple method for correction of cubitus varus deformity in children. It can effectively solve the instability of lateral condylar process and osteotomy. This method has few complications, beautiful appearance and good function. It is worth popularizing.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8

【参考文献】