摘要
目的探讨一期原位固定二期截骨矫形分期联合手术矫治儿童肱骨外髁骨不连合并肘外翻的治疗效果。方法回顾性分析2016年1月至2018年3月西安交通大学附属红会医院小儿骨科诊疗中心收治8例儿童肱骨外髁骨不连合并肘外翻患儿资料。男5例,女3例;左侧5例,右侧3例;受伤年龄为6~14岁(平均10岁);受伤至手术时间2~6年(平均4年)。一期手术采用骨不连断端清理,骨块原位空心钉加压固定,自体髂骨植骨术。在骨不连愈合和肘关节功能正常后二期行肱骨髁上内翻截骨矫形术。记录并比较术前与末次随访时肘关节活动度、提携角和Mayo肘关节功能评分系统(MEPS)评定疗效。结果所有患儿术后均获随访,平均随访时间44.5个月(27~64个月)。一期手术后肱骨外髁陈旧性骨折骨不连愈合时间平均81.3 d(55~120 d);二期截骨矫形手术后所有截骨均获愈合,愈合时间平均51.1 d(45~60 d)。术前、末次随访时患儿肘关节活动度分别为129.0°±4.6°、138.0°±5.4°,差异有统计学意义(P<0.001)。8例患儿健侧的提携角平均5.4°(3°~8°)。术前、末次随访时患儿患侧的提携角分别是31.9°±4.7°(25°~42°)、4.0°±2.2°(1°~8°),差异有统计学意义(P<0.05)。术前MEPS评分为(57.5±6.5)分,良4例,差4例;末次随访时MEPS评分为(95.9±3.4)分,优秀6例,良2例,差异有统计学意义(P<0.05)。结论采用一期原位固定骨不连断端清理,骨块原位空心钉加压固定,自体髂骨植骨;二期肱骨髁上内翻截骨矫形治疗儿童肱骨外髁骨不连合并肘外翻畸形,手术效果良好,术中对外髁骨块血供的保护是手术治疗的关键。
Objective To evaluate the treatment of nonunion of lateral humeral condyle complicated with cubitus valgus with primary fixation in situ and secondary supracondylar varus osteotomy.Methods A retrospective analysis was made of the 8 children who had been treated for nonunion of lateral humeral condyle complicated with cubitus valgus at Department of Pediatric Orthopedics,Honghui Hospital from January 2016 to March 2018.They were 5 boys and 3 girls with 5 left and 3 right sides involved.Their age at injury ranged from 6 to 14 years(average,10 years)and the duration from injury to operation from 2 to 6 years(average,4 years).At the primary stage,the fragments were fixated in situ with compressive cannulated screws after cleaning the nonunion ends,followed by iliac autograft.At the secondary stage,the humeral supracondylar varus osteotomy was performed after the nonunion was healed and the elbow range of motion recovered.The therapeutic effects were assessed by comparing the elbow range of motion,carrying angle and Mayo elbow performance score(MEPS)between preoperation and the final follow-up.Results All the patients were followed up for an average of 44.5 months(range,from 27 to 64 months).The average healing time for obsolete nonunion of lateral humeral condyle was 81.3 days(range,from 55 to 120 days)after the primary operation and that for supracondylar varus osteotomy 51.1 days(range,from 45 to 60 days)after the secondary operation.The elbow range of motion was 129.0°±4.6°before operation and 138.0°±5.4°at the final follow-up,showing a significant difference(P<0.001).The average carrying angle at the healthy side in 8 children was 5.4°(range,from 3°to 8°).The carrying angle at the affected side was 31.9°±4.7°(range,from 25°to 42°)before operation and 4.0°±2.2°(range,from 1°to 8°)at the final follow-up,showing a significant difference(P<0.05).Their preoperative MEPS was 57.5±6.5(4 good cases and 4 poor ones)but 95.9±3.4(6 excellent cases and 2 good ones)at the final follow-up,showing a significant difference(P<0.05).Conclusions Treatment of nonunion of lateral humeral condyle complicated with cubitus valgus can be effectively carried out by cleaning fibrous tissue in the nonunion gap,iliac autograft and fragments fixation in situ with compressive cannulated screws at the primary stage and supracondylar varus osteotomy at the secondary stage.Intraoperative preservation of the blood supply to the nonunited fragments is the key to successful management.
作者
李敏
孟海亮
陈彦飞
孙川
陆清达
屈继宁
苏菲
吴永涛
颉强
Li Min;Meng Hailiang;Chen Yanfei;Sun Chuan;Lu Qingda;Qu Jining;Su Fei;Wu Yongtao;Jie Qiang(Department of Pediatric Orthopedics,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第5期400-404,共5页
Chinese Journal of Orthopaedic Trauma
基金
国家自然科学基金(81871743)
陕西省自然科学基础研究计划(2017ZDJC-12)。
关键词
骨折
不愈合
肘关节
儿童
肘外翻
Fractures,ununited
Elbow joint
Child
Cubitus valgus
