Yuan Ganfeng,Liu Kun,Mei Haibo.Clinical analysis of primary distal humeral varus osteotomy plus internal fixation with bone grafting for old lateral condyle humeral fracture with elbow valgus[J].Journal of Clinical Pediatric Surgery,2020,19(09):825-829,857.[doi:10.3969/j.issn.1671-6353.2020.09.013]
一期肱骨远端内翻截骨与植骨内固定治疗陈旧性肱骨外髁骨折合并肘外翻的临床疗效分析
- Title:
- Clinical analysis of primary distal humeral varus osteotomy plus internal fixation with bone grafting for old lateral condyle humeral fracture with elbow valgus
- 分类号:
- R726.8;R681.7
- 摘要:
- 目的 探讨采用一期肱骨远端内翻截骨、陈旧性肱骨外髁骨折处自体骨植骨内固定治疗儿童陈旧性肱骨外髁骨折并肘外翻的疗效。方法 2013年1月至2018年1月湖南省儿童医院共收治10例肱骨外髁陈旧性骨折不愈合继发肘外翻畸形患儿，其中男8例，女2例；年龄5~14岁，平均10.5岁；右侧8例，左侧2例；患儿受伤时间为3~10年，平均6年；提携角20°~40°者8例，40°~50°者2例。所有病例肘关节功能有不同程度受限，其中3例有尺神经麻痹症状。术前测量患侧的外翻角及对侧的提携角。均采用一期肱骨远端内翻截骨克氏针内固定，陈旧性肱骨外髁骨折处自体骨植骨，采用空心拉力螺钉+克氏针内固定术治疗，术后随访观察临床疗效。结果 10例均获随访，平均随访时间22个月（12~60个月）。患儿原骨折不愈合处及肱骨远端截骨处均达到骨性愈合，肱骨截骨端骨性愈合时间5~12周，平均7周；肱骨外髁骨折端愈合时间7~24周，平均11.9周。9例患侧提携角恢复正常，1例患侧提携角20°，但肘关节功能正常。术前患侧肘关节活动度平均为（92.5±20.8）°，术后1年时平均为（129.0±12.2）°，二者差异有统计学意义（t=7.639，P<0.001）。3例尺神经麻痹症状消失，1例空心拉力螺钉断裂，予再次手术。结论 采用一期肱骨远端内翻截骨、陈旧性肱骨外髁骨折处自体骨植骨、空心拉力螺钉+克氏针内固定手术方式治疗儿童陈旧性肱骨外髁骨折并肘外翻畸形，术后肘关节外观、功能、稳定性恢复好，可避免二期手术，是治疗该病的理想手术方法。
- Abstract:
- Objective To explore the clinical efficacy of primary distal humeral varus osteotomy plus autogenous bone grafting and internal fixation for old lateral condyle humeral fracture with cubitus valgus deformity in children. Methods From January 2013 to January 2018,10 children with cubitus valgus deformity secondary to a nonunion of old humeral condylar fracture were treated.There were 8 boys and 2 girls with an average age of 10.5(5-14) years.The involved side was right (n=8) and left (n=2).The average age of injury was 6(3-10) years.The carrying angles were 20-40 degrees (n=8) and 40-50 degrees (n=2).Elbow joint functions were somewhat limited and 3 children developed ulnar nerve paralysis.Valgus angle of affected side and carrying angle of opposite side were measured preoperatively.All children underwent primary internal fixation with Kirschner wire for distal humeral varus osteotomy,autogenous bone grafting for old humeral lateral condyle fracture,hollow lag screwing and internal fixation of Kirschner wire.Follow-up observations were conducted postoperatively. Results During an average follow-up period of 22(12-60) months,all of them achieved bone healing.The average healing time of humeral osteotomy end was 7(5-12) weeks and the average healing time of fracture end of lateral humeral condyle 11.9(7-24) weeks.For 9 cases,extremity lifting angle was normal.One child had an extremity lifting angle of 20" and yet elbow joint function remained normal.The average range of motion of elbow joint at affected side was 92.5±20.8 pre-operation and 129.0±12.2 at 1 year post-operation.And the difference was statistically significant (t=7.639,P<0.001).The symptoms of ulnar nerve disappeared (n=3) and hollow tension screw rupture led to re-operation (n=1). Conclusion Primary distal humeral varus osteotomy,autogenous bone grafting for old lateral condyle humeral fracture,hollow lag screwing and internal fixation of Kirschner wire are efficacious for old lateral condyle humeral fracture with cubitus vagus deformity in children.The postoperative appearance,function and stability of elbow joint recover well so that second-stage operation is unnecessary.
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备注/Memo
收稿日期:2019-11-02。
通讯作者:刘昆,Email:flydragon@126.com