• 四川大學(xué)華西醫(yī)院小兒外科（成都，610041）;

目的 探討采用外側(cè)閉合楔形截骨術(shù)矯正兒童創(chuàng)傷性肘內(nèi)翻畸形的療效。 方法 1996 年7 月－2010 年6 月，收治兒童肱骨髁上骨折后肘內(nèi)翻畸形20 例。男13 例，女7 例。年齡7 ～ 14 歲，平均10.6 歲。左側(cè)12 例，右側(cè)8 例。13 例曾于外院行閉合復(fù)位經(jīng)皮克氏針內(nèi)固定、石膏外固定，7 例誤診為關(guān)節(jié)脫位和軟組織損傷行石膏外固定。傷后2 ～ 12 年出現(xiàn)肘關(guān)節(jié)外觀異常和活動(dòng)受限。術(shù)前肘關(guān)節(jié)活動(dòng)范圍為屈100 ～ 150°，平均133.0°；伸0 ～ 24°，平均11.7°。肘內(nèi)翻角度為20 ～ 50°，平均32.1°。均采用外側(cè)閉合楔形截骨術(shù)治療。 結(jié)果 術(shù)后切口均Ⅰ期愈合，無相關(guān)并發(fā)癥發(fā)生。17 例患兒獲隨訪，隨訪時(shí)間1 ～ 14 年，平均5 年。X 線片示截骨區(qū)均達(dá)骨性愈合，愈合時(shí)間為5 ～ 8 周，平均6 周。肘關(guān)節(jié)內(nèi)翻畸形均獲矯正，末次隨訪時(shí)肘關(guān)節(jié)活動(dòng)范圍為屈110 ～ 150°，平均135.9°；伸0 ～ 27°，平均12.9°。根據(jù)Jupiter 等肘關(guān)節(jié)評(píng)分系統(tǒng)評(píng)價(jià)肘關(guān)節(jié)功能，優(yōu)14 例，良2 例，可1 例，優(yōu)良率94.1%。1 例術(shù)后1 個(gè)月拔除克氏針后畸形復(fù)發(fā)，1 年后再次行外側(cè)閉合楔形截骨術(shù)矯正。 結(jié)論 外側(cè)閉合楔形截骨術(shù)具有操作簡(jiǎn)便、手術(shù)并發(fā)癥少等優(yōu)點(diǎn)，是治療兒童創(chuàng)傷性肘內(nèi)翻畸形有效方法之一。

引用本文： 楊健,何濤貞,劉少鋒,彭明惺,劉敏. 外側(cè)閉合楔形截骨術(shù)矯正兒童創(chuàng)傷性肘內(nèi)翻畸形. 中國(guó)修復(fù)重建外科雜志, 2012, 26(6): 657-660. doi: 復(fù)制

1. 潘少川. 實(shí)用小兒骨科學(xué). 2版. 北京: 人民衛(wèi)生出版社, 2005: 443-450.
2. Storm SW, Williams DP, Khoury J, et al. Elbow deformities after fracture. Hand Clin, 2006, 22(1): 121-129.
3. Murase T, Oka K, Moritomo H, et al. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg (Am), 2008, 90(11): 2375-2389.
4. Husban FM, Odat MM, Dwiri MD. Lateral closing wedge supracondylar humeral osteotomy for treatment of post-traumatic cubitus varus. JRMS, 2010, 17(3): 33-38.
5. Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
6. Jupiter JB, Neff U, Holzach P, et al. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg (Am), 1985, 67(2): 226-239.
7. 嚴(yán)世貴, 潘志軍. 臨床小兒骨科學(xué). 北京: 中國(guó)醫(yī)藥科技出版社, 2010: 115-118.
8. 郭躍明, 王志遠(yuǎn), 鄒勇根, 等. 肱骨髁上骨折并發(fā)肘內(nèi)翻畸形病理形態(tài)學(xué)分析. 中國(guó)矯形外科雜志, 2004, 12(10): 725-727.
9. Davids JR, Lamoreaux DC, Brooker RC, et al. Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop, 2011, 31(4): 353-365.
10. Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
11. 張金哲, 潘少川, 黃澄如. 實(shí)用小兒外科學(xué). 杭州: 浙江科學(xué)技術(shù)出版社, 2003: 1290-1300.
12. Cho CH, Song KS, Min BW, et al. Long-term results of remodeling of lateral condylar prominence after lateral closed-wedge osteotomy for cubitus varus. J Shoulder Elbow Surg, 2009, 18(3): 478-483.
13. 張問廣, 胡月光. 肱骨髁上骨折并發(fā)肘內(nèi)翻的臨床與應(yīng)用解剖研究. 臨床小兒外科雜志, 2008, 7(3): 43-44.
14. Buß FR, Schulz AP, Lill H, et al. Supracondylar osteotomies of posttraumatic distal humeral deformities in young adults——technique and results. Open Orthop J, 2011, 5: 389-394.
15. Skaggs DL, Glassman D, Weiss JM, et al. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. Journal of Children’s Orthopaedics, 2011, 5(4): 305-312.
16. Bali K, Sudesh P, Krishnan V, et al. Modified step-cut osteomy for post-traumatic cubitus varus: our experience with 14 children. Orthop Traumatol Surg Res, 2011, 97(7): 741-749.
17. Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a teaching hospital. J Bone Joint Surg (Br), 2006, 88(3): 362-365.
18. Feng C, Gou Y, Zhu Z, et al. Biomechanical analysis of supracondylar humerus fractures pinning for fractures with coronal lateral obliquity. J Pediatr Orthop, 2012, 32(2): 196-200.
19. Srivastava AK, Srivastava D, Gaur S. Lateral close wedge osteotomy for cubitus varus deformity. Indian J Orthop, 2008, 42(4): 466-470.
20. Hamdi A, Poitras P, Louati H, et al. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2010, 30(2): 135-139.
21. Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
22. Moon MS, Kim SS, Kim ST, et al. Lateral closing wedge osteotomy with or without medialisation of the distal fragment for cubitus varus. J Orthop Surg (Hong Kong), 2010, 18(2): 220-223.
  1. 1. 潘少川. 實(shí)用小兒骨科學(xué). 2版. 北京: 人民衛(wèi)生出版社, 2005: 443-450.
  2. 2. Storm SW, Williams DP, Khoury J, et al. Elbow deformities after fracture. Hand Clin, 2006, 22(1): 121-129.
  3. 3. Murase T, Oka K, Moritomo H, et al. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg (Am), 2008, 90(11): 2375-2389.
  4. 4. Husban FM, Odat MM, Dwiri MD. Lateral closing wedge supracondylar humeral osteotomy for treatment of post-traumatic cubitus varus. JRMS, 2010, 17(3): 33-38.
  5. 5. Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
  6. 6. Jupiter JB, Neff U, Holzach P, et al. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg (Am), 1985, 67(2): 226-239.
  7. 7. 嚴(yán)世貴, 潘志軍. 臨床小兒骨科學(xué). 北京: 中國(guó)醫(yī)藥科技出版社, 2010: 115-118.
  8. 8. 郭躍明, 王志遠(yuǎn), 鄒勇根, 等. 肱骨髁上骨折并發(fā)肘內(nèi)翻畸形病理形態(tài)學(xué)分析. 中國(guó)矯形外科雜志, 2004, 12(10): 725-727.
  9. 9. Davids JR, Lamoreaux DC, Brooker RC, et al. Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus. J Pediatr Orthop, 2011, 31(4): 353-365.
  10. 10. Zhang YZ, Lu S, Chen B, et al. Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elbow Surg, 2011, 20(1): 51-56.
  11. 11. 張金哲, 潘少川, 黃澄如. 實(shí)用小兒外科學(xué). 杭州: 浙江科學(xué)技術(shù)出版社, 2003: 1290-1300.
  12. 12. Cho CH, Song KS, Min BW, et al. Long-term results of remodeling of lateral condylar prominence after lateral closed-wedge osteotomy for cubitus varus. J Shoulder Elbow Surg, 2009, 18(3): 478-483.
  13. 13. 張問廣, 胡月光. 肱骨髁上骨折并發(fā)肘內(nèi)翻的臨床與應(yīng)用解剖研究. 臨床小兒外科雜志, 2008, 7(3): 43-44.
  14. 14. Buß FR, Schulz AP, Lill H, et al. Supracondylar osteotomies of posttraumatic distal humeral deformities in young adults——technique and results. Open Orthop J, 2011, 5: 389-394.
  15. 15. Skaggs DL, Glassman D, Weiss JM, et al. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. Journal of Children’s Orthopaedics, 2011, 5(4): 305-312.
  16. 16. Bali K, Sudesh P, Krishnan V, et al. Modified step-cut osteomy for post-traumatic cubitus varus: our experience with 14 children. Orthop Traumatol Surg Res, 2011, 97(7): 741-749.
  17. 17. Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a teaching hospital. J Bone Joint Surg (Br), 2006, 88(3): 362-365.
  18. 18. Feng C, Gou Y, Zhu Z, et al. Biomechanical analysis of supracondylar humerus fractures pinning for fractures with coronal lateral obliquity. J Pediatr Orthop, 2012, 32(2): 196-200.
  19. 19. Srivastava AK, Srivastava D, Gaur S. Lateral close wedge osteotomy for cubitus varus deformity. Indian J Orthop, 2008, 42(4): 466-470.
  20. 20. Hamdi A, Poitras P, Louati H, et al. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop, 2010, 30(2): 135-139.
  21. 21. Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
  22. 22. Moon MS, Kim SS, Kim ST, et al. Lateral closing wedge osteotomy with or without medialisation of the distal fragment for cubitus varus. J Orthop Surg (Hong Kong), 2010, 18(2): 220-223.