Zhao Guoqiang,Zhao Xufei,Feng Tingting.Efficacy analysis of treating pediatric cubitus varus with osteotomy by Ilizarov versus simple Kirschner wire fixation[J].Journal of Clinical Pediatric Surgery,,18():675-680,685.[doi:10.3969/j.issn.1671-6353.2019.08.012]
Efficacy analysis of treating pediatric cubitus varus with osteotomy by Ilizarov versus simple Kirschner wire fixation
- Keywords:
- Fractures; Bone; Humerus; Osteotomy; Kirschner Wire; Cubitus vars/CO; Child
- CLC:
- R683.41;R619
- Abstract:
- Objective To compare the efficacies of treating pediatric cubitus varus with osteotomy by ilizarov versus simple Kirschner wire fixation.Methods From May 2008 to May 2017,a total of 34 children of cubitus varus were divided into two groups of osteotomy with Ilizarov (OI,n=16) and osteotomy with Kirschner wire fixation (SOKWF,n=18).In group OI,there were 13 boys and 3 girls with an average age of 7.3±2.1 years.The involved side was left (n=9) and right (n=7); in group SOKWF,there were 12 boys and 6 girls with an average age of 8.2±1.9 years.The involved side was left (n=7) and right (n=11).The preoperative data of two groups were compared with regards to various intraoperative indices,postoperative complications and efficacy.Elbow function was evaluated according to the modified Flynn standard.Results The average follow-up period was 39 (15-98) months.LOS (length of stay) was 5.5±1.5 and 6.4±2.4 days in OI and SOKWF groups respectively.In group OI,the postoperative complications were nerve contusion (n=2) and needle infection (n=1); in group SOKWF,there was ulnar nerve contusion (n=4).No significant difference existed for in all indicators (P>0.05).Incision length was 1.5±0.9 and 3.8±1.1 cm; blood loss volume 10.4±1.5 and 25.4±2.5 ml; operative duration 1.8±0.3 and 0.9±0.2 h; complete healing time 48.5±3.9 and 28±4.5 days; demolition of internal and external fixed time 31.4±5.7 and 1±0.14 min.The inter-group differences were statistically significant (P<0.05).Then the carrying angle were inverted 15.2°±2.4° and 16.3°±1.9° before operation while carrying angle were valgus 11.2°±1.5° and 10.8°±1.7° post-operation respectively.Statistically significant inter-group differences existed in correction angles at pre and post-operation (P<0.05).The eligible rates were 93.75%and 94.4% for OI and SOKWF groups respectively.The difference was not statistically significant (P<0.05).Conclusion Osteotomy of ilizarov versus simple Kirschner wire fixation is equally effective for pediatric cubitus varus.However,the latter offers more advantages in terms of shorter operative duration,complete healing time of osteotomy and demolition of internal fixed time while the former has minimal scar and no deformity of lateral condyle.
References:
1 田世双,冯晓娜.改良French内固定术治疗儿童肘内翻畸形的临床观察[J].创伤外科杂志,2012,14(3):215-216.DOI:10.3969/j.issn.1009-4237.2012.03.008.Tian SS,Feng XN.Clinical observation on modified French internal fixation in treating children with cubitus varus deformity[J].J Trauma Surg,2012,14(3):215-216.DOI:10.3969/j.issn.1009-4237.2012.03.008.
2 Brubacher JW,Dodds SD.Pediatric supracondylar fractures of the distal humerus[J].Curr Rev Musculoskelet Med,2008,1(3-4):190-196.DOI:10.1007/s12178-008-9027-2.
3 王亦璁,姜保国.骨与关节损伤[M].第5版,北京:人民卫生出版社,2012:795-798.Wang YC,Jiang BG.Bone and Joint Trauma[M].Fifth Edition,Beijing:People’s Medical Publishing House,2012:795-798.
4 Mangwani J,Nadarajah R,Paterson JM.Supracondylar humeral fractures in children:ten years’ experience in a teaching hospital[J].Bone Joint Surg,2006,88(3):362-365.DOI:10.1302/0301-620X.88B3.16425.
5 张天久,俞松,杨小红.儿童肱骨远端骨折致肘内翻形成原因的探讨[J].中国骨与关节杂志,2015(6):473-476.DOI:10.3969/j.issn.2095-252X.2015.06.011.Zhang TJ,Yu S,Yang XH.A discussion on the causes of children distal humerus fractures leading to cubitus varus[J].Chinese Journal of Bone and Joint,2015(6):473-476.DOI:10.3969/j.issn.2095-252X.2015.06.011.
6 叶丙霖,李盛华,周明旺,等.儿童肱骨髁上骨折并发肘内翻治疗的研究进展[J].中国矫形外科杂志,2016,24(24):2269-2273.DOI:10.3977/j.issn.1005-8478.2016.24.13.Ye BL,Li SH,Zhou MW,et al.Treatment of supracondylar fracture of the humerus with cubitus varus in children[J].Orthopedic Journal of China,2016,24(24):2269-2273.DOI:10.3977/j.issn.1005-8478.2016.24.13.
7 张元智,陆声,杨勇,等.计算机辅助设计截骨导航模板治疗肘内翻畸形的初步应用[J].中华小儿外科杂志,2010,31(3):180-182.DOI:10.3760/cma.j.issn.0253-3006.2010.03.007.Zhang YZ,Lu S,Yang Y,et al.Application of computer-aided design osteotomy navigational template for treatment of cubitus varus deformity,a pilot study[J].Chin J Pediatr Surg,2010,31(3):180-182.DOI:10.3760/cma.j.issn.0253-3006.2010.03.007.
8 张问广,胡月光.肱骨髁上骨折并发肘内翻的临床与应用解剖研究[J].临床小儿外科杂志,2008,(3):43-44.DOI:10.3969/j.issn.1671-6353.2008.03.016.Zhang WG,Hu YG.Clinical and applied anatomic study of suprocondylar humeral fractures with elbow varus[J].J Clin Ped Sur,2008,(3):43-44.DOI:10.3969/j.issn.1671-6353.2008.03.016.
9 孔建中,史建靖,翁益民,等.Baumann角在儿童肱骨髁上骨折经皮固定术中的临床应用[J].中华小儿外科杂志,2005,26(5):249-252.DOI:10.3760/cma.j.issn.0253-3006.2005.05.009.Kong JZ,Shi JJ,Weng YM,et al.Clinical significance of Baumann’s angle in the percutaneous pinning fixation for supracondylar fractures of the humerus in children[J].Chin J Pediatr Surg,2005,26(5):249-252.DOI:10.3760/cma.j.issn.0253-3006.2005.05.009.
10 范存义,阮洪江,汪银锋,等.微创截骨钢缆接骨术治疗儿童肘内翻畸形[J].中华创伤骨科杂志,2009,11(12):1130-1132.DOI:10.3760/cma.j.issn.1671-7600.2009.12.008.Fan CY,Ruan HJ,Wang YF.et al.Mini-invasive osteotomy and cable osteosynthesis in the treatment of adolescent cubitus varus[J].Chin J Orthop Trauma,2009,11(12):1130-1132.DOI:10.3760/cma.j.issn.1671-7600.2009.12.008.
11 张金哲,潘少川,黄澄如,等.实用小儿外科学[M].杭州:浙江科学技术出版社,2003:1290-1300.Zhang JZ,Pan SC,Huang CR,et al.Practical Pediatric Surgery[M].Hangzhou:Zhejiang Science & Technology Press,2003:1290-1300.
12 O’Driscoll SW,Spinner RJ,Mckee MD,et al.Tardy posterolateral rotatory instability of the elbow due to cubitus varus[J].J Bone Joint Surg Am,2001,83 (9):1358-1369.DOI:10.2106/00004623-200109000-00011.
13 Omoris,MuraseT,OkaK,et al.Postoperative accuracy analysis of three-dimensional corrective osteotomy for cubitus varus deformity with a custom-made surgical guide based on computer simulation[J].J Shoulder elbow Surg,2015,24(2):242-249.DOI:10.1016/j.jse.2014.08.020.
14 Slongo T.Behandlung des Posttraumatischen Cubitus varus beikindern und Jugendlichen[J].Operative Orthop die und Traumatologie,2015,27(3):194-209.DOI:10.7892/boris.75055.
15 Koch PP,Exner GU.Supracondylar medial open wedge osteotomy with external fixation for cubitus varus deformity[J].J Pediatr Orthop B,2003,12(2):116-122.DOI:10.1097/01.bpb.0000049571.52224.c8.
16 Kumar K,Sharma VK,Sharma R,et al.Correction of cubitus varus by French or dome osteotomy:a comparative study[J].J Trauma,2000,49(4):717-721.DOI:10.1097/00005373-200010000-00021.
17 Jain AK,Dhammi IK,Arora A,et al.Cubitus varus:problem and solution[J].Arch Orthop Trauma Surg,2000,120(7-8):420-425.DOI:10.1007/s004029900102.
18 Abdelmotaal HM,Abutalib RA,Khoshhal KI.The closed wedge counter shift osteotomy for the correction of post-traumatic cubitus varus[J].J Pediatr Orthop B,2013,22(4):376-382.DOI:10.1097/BPB.0b013e328360c528.
19 马长生,苏驰.手法整复与经皮钢针内固定治疗儿童GartlandⅢ型肱骨髁上骨折1100例[J].临床小儿外科杂志,2015,14(3):231-233.DOI:10.3969/j.issn.1671-6353.2015.03.020.Ma ZS,Su C.Treatment of supracondylar fractures of the humerus in children with manipulative closed reduction and improved percutaneous kirschner wire inter-fixation for 1100 cases[J].J Clin Ped Sur,2015,14(3):231-233.DOI:10.3969/j.issn.1671-6353.2015.03.020.
20 Ippolito E,Moneta MR,D’Arrigo C.Post-traumatic cubitus varus:long-term follow-up of corrective supracondylar humeral osteotomy in children[J].J Bone Joint Surg Am,1990,72(5):757-65.DOI:10.1097/01241398-199101000-00036.
21 唐进,梅海波,刘昆,等.肱骨远端闭合性侧梯形截骨治疗儿童严重肘内翻[J].中华小儿外科杂志,2009,30(11):809-811.DOI:10.3760/cma.j.issn.0253-3006.2009.11.022.Tang J,Mei HB,Liu K,et al.The treatment of severe elbow varus in children with distal and closed lateral pedicled of the humerus[J].Chin J Pediatr Surg,2009,30(11):809-811.DOI:10.3760/cma.j.issn.0253-3006.2009.11.022.
22 Ilizarov GA.Transosseous osteosynthesis,theoretical and clinical aspects of regeneration and growth of tissue[M].Berlin Heidelberg:Springer Verlag,1992:3-279.
23 李刚,秦泗河.牵拉成骨技术的基础研究进展与带给骨科的启示[J].中华外科杂志,2005,43(8):540-543.DOI:10.3760/j:issn:0529-5815.2005.08.016.Li G,Qin SH.Advances in basic research on distraction osteogenesis and implications for orthopedic[J].Chin J Surg,2005,43(8):540-543.DOI:10.3760/j:issn:0529-5815.2005.08.016.
24 Koch PP,Exner GU.Supracondylar medial open wedge osteotomy with external fixation for cubitus varus deformity[J].J Pediatr Orthop B,2003,12(2):116-122.DOI:10.1097/01.bpb.0000049571.52224.c8.
25 Levine MJ,Horn BD,Pizzutillo PD.Treatment of posttraumatic cubitus varus in the pediatric population with humeral osteotomy and external fixation[J].J Podiatr orthop,1996,16(5):597-601.DOI:10.1097/00004694-199609000-00010.
26 Kristiansen LP,Steen H.Reduced lengthening index by use of bifocal osteotomy in the tibia:comparison of monofocal and bifocal procedures with the Ilizarov external fixator[J].Acta Orthop Stand,2009,73(1):93-97.DOI:10.1080/000164702317281486
Memo
收稿日期:2018-08-22。
基金项目:浙江省卫生厅医药科技项目（编号：2017KY444）