摘要
目的评估自行设计的尺骨近端旋转截骨技术治疗先天性桡骨头前脱位的疗效。方法选取2008年4月至2015年12月我院收治的无明确外伤史的桡骨头前脱位患儿11例,首例术前诊断为陈旧性孟氏骨折,术中发现其桡骨头前脱位,上尺桡关节位置异常,按陈旧性孟氏骨折的处理办法桡骨头不能复位,将尺骨上段截骨,远端向外后侧旋转,桡骨头可获得复位。基于这种发现,对其余10例无明确外伤史的先天性桡骨头前脱位患儿术前常规行MRI检查,其主要的病理改变为上尺桡关节位置异常,位于前外侧而不是外侧,由此应用自行设计的尺骨近端旋转截骨术,将上尺桡复合体向后外侧旋转,从而使肱桡关节复位。采用尺骨近端旋转截骨术共治疗11例先天性桡骨头前脱位患儿,其中男7例,女4例,年龄2~12岁,平均6.1岁。对术前和术后的影像学和临床功能进行评估,回顾性分析术后疗效。结果本组11例均获12~70个月随访,平均26个月。肘关节的X线片提示肱桡关节均复位,无桡骨头脱位的复发,无截骨处不愈合、尺骨近端发育无异常。无伤口感染、神经损伤。提携角明显减小(P<0.05),肘关节的稳定性和屈曲幅度得到明显改善(P<0.05)。结论尺骨近端旋转截骨术治疗先天性桡骨头前脱位有效,临床疗效满意。
Objective To evaluate the curative results of self-designed proximal ulnar rotation osteotomy for the treatment of congenital anterior dislocation of the radial head. Methods From April 2008 to December 2015, 19 children with anterior dislocation of the radial head without a history of trauma were treated in our hospital. Firstly, one child was radiographically diagnosed with old Monteggia fracture before surgery with abnormal position of proximal radioulnar joint, which could not be treated by using old Monteggia procedures. We repositioned the radial head by cutting the proximal ulna and rotated the distal ulna back-outside. The MRI examination was performed in 18 cases of anterior dislocation of the radial head without a history of trauma before surgery. It showed that there were 8 cases of old Monteggia fractures and 10 cases of congenital anterior dislocation of the radial head. The main pathological changes included abnormal position of the proximal radioulnar joint, which was located in the anterior lateral side of the ulna rather than the outside. Based on the pathological changes, we designed proximal ulnar rotation osteotomy with ulnar radial complex on the backward of the lateral rotation to reset the radiocapitellar joint. Among the 11 patients treated with proximal ulnar rotation osteotomy, there were 7 boys and 4 girls whose average age was 6.1 years （ range： 2 - 12 years ）. The curative results were retrospectively analyzed for 11 children with congenital anterior dislocation of the radial head by preoperative and postoperative radiographical and clinical evaluation of the elbow functions. Results All the patients were followed up for an average period of 26 months （ range： 12 - 70 months ）. The radiography of the elbow showed that the radiocapitellar joint was reduced in all the patients, and radial head dislocation did not recur. No ulnar nonunion, elbow osteoarthritis, wound infection or nerve injury was observed in these patients. The carrying angle was obviously decreased （ P 〈 0.05 ）. The elbow stability and range of elbow flexion motion were obviously improved （ P 〈 0.05 ）. Conclusions The follow-up results have shown that proximal ulnar rotation osteotomy is an effective method for the treatment of congenital anterior dislocation of the radial head.
作者
苗武胜
汪兵
吴革
吴永涛
姜海
屈继宁
李敏
王晓威
梁小菊
MIAO Wu-sheng WANG Bing WU Ge WU Yong-tao JIANG Hai QU Ji-ning LI Min WANG Xiao-wei LIANG Xiao-ju(Department of Pediatric Orthopedics, Honghui Hospital, Xi＇an Jiaotong University, Xi＇an, Shaanxi, 710054, China)
出处
《中国骨与关节杂志》
CAS
2017年第7期512-516,共5页
Chinese Journal of Bone and Joint
关键词
桡骨
脱位
先天性桡骨脱位
尺骨旋转截骨
复位
Radius
Dislocations
Congenital dislocation of the radial head
Ulnar rotation osteotomy
Reset
