Zhu Lining,Xia Tian,Zhou Min,et al.Clinical research of supracondylar osteotomy determined by bisectors for cubitus varus deformity in children[J].Journal of Clinical Pediatric Surgery,2023,22(05):460-464.[doi:10.3760/cma.j.cn101785-202205052-011]
等分线法肱骨髁上截骨治疗儿童肘内翻畸形的临床研究
- Title:
- Clinical research of supracondylar osteotomy determined by bisectors for cubitus varus deformity in children
- Keywords:
- Elbow Joint; Osteotomy; Surgical Procedures; Operative; Child
- 摘要:
- 目的 初步探讨等分线法肱骨髁上截骨治疗儿童肘内翻畸形的临床疗效。方法 回顾性分析2016年1月至2020年12月海南省妇女儿童医学中心小儿骨科和复旦大学附属儿科医院小儿骨科共35例采用等分线法肱骨髁上截骨治疗的肘内翻畸形患儿临床资料。男27例、女8例,左侧21例、右侧14例;测量35例患儿术前、术后的提携角、Baumann角、肱骨干轴线与肱骨远端干骺端夹角,采用Mayo评分系统评定肘关节功能(包括疼痛、运动范围、稳定性、日常生活功能4个维度)。结果 35例患儿均获得完整随访。术前提携角(-23.0±7.81)°、Baumann角(3.74±1.35)°、肱骨干轴线与肱骨远端干骺端夹角(22.69±6.39)°;术后提携角(10.51±3.62)°、Baumann角(18.44±4.02)°、肱骨干轴线与肱骨远端干骺端夹角(4.01±1.93)°;对比35例患儿术前和术后的提携角、Baumann角及肱骨干轴线与肱骨远端干骺端夹角,差异均有统计学意义(P＜0.05)。采用Mayo肘关节功能评分标准评定疗效,优良率为97.1％(34/35)。结论 等分线法肱骨髁上截骨设计合理,可获得较好的肘内翻矫正效果。
- Abstract:
- Objective To explore the clinical efficacy and advantages of supracondylar osteotomy determined by bisectors for cubitus varus deformity in children.Methods Clinical data were retrospectively reviewed for 35 children with cubitus varus deformity treated by supracondylar osteotomy determined by bisectors from January 2016 to December 2020.There were 27 boys and 8 girls.The involved side was left (n=21) and right (n=14).Preoperative carrying angle,Baumann angle and Mayo score were measured for evaluating elbow functions.pain,rang of motion,stability and daily activity ability.Results All of them were followed up completely.The average preoperative values of carrying angle,mean values of Baumann angle and angle between axis of shaft of humerus and metaphysis of distal humerus were (-23.0±7.81)°,(3.74±1.35)° and (22.69±6.39)° respectively,At the final follow-up,mean values of carrying angle and Baumann angle were (10.51±3.62)° and (18.44±4.02)°and angle between axis of shaft of humerus and metaphysis of distal humerus (4.01±1.93)° respectively.There were significant statistical differences (P<0.05).The efficacy was evaluated by Mayo elbow function score and the excellent/good rate was 97.1%(34/35).Conclusion Supracondylar osteotomy determined by bisectors is efficacious and offers an excellent correction of cubitus varus.
参考文献/References:
[1] Davids JR,Lamoreaux DC,Brooker RC,et al.Translation step-cut osteotomy for the treatment of posttraumatic cubitus varus[J].J Pediatr Orthop,2011,31(4):353-365.DOI:10.1097/BPO.0b013e31821723a6.
[2] Lee SC,Shim JS,Sul EJ,et al.Remodeling after lateral closing-wedge osteotomy in children with cubitus varus[J].Orthopedics,2012,35(6):e823-e828.DOI:10.3928/01477447-20120525-19.
[3] Abe M,Ishizu T,Morikawa J.Posterolateral rotatory instability of the elbow after posttraumatic cubitus varus[J].J Shoulder Elbow Surg,1997,6(4):405-409.DOI:10.1016/S1058-2746(97)90011-2.
[4] Mitsunari A,Muneshige H,Ikuta Y,et al.Internal rotation deformity and tardy ulnar nerve palsy after supracondylar humeral fracture[J].J Shoulder Elbow Surg,1995,4(1Pt 1):23-29.DOI:10.1016/S1058-2746(10)80004-7.
[5] Spinner RJ,Goldner RD.Snapping of the medial head of the triceps and recurrent dislocation of the ulnar nerve.Anatomical and dynamic factors[J].J Bone Joint Surg Am,1998,80(2):239-247.DOI:10.2106/00004623-199802000-00011.
[6] Davids JR,Maguire MF,Mubarak SJ,et al.Lateral condylar fracture of the humerus following posttraumatic cubitus varus[J].J Pediatr Orthop,1994,14(4):466-470.DOI:10.1097/01241398-199407000-00009.
[7] 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.
[8] Solfelt DA,Hill BW,Anderson CP,et al.Supracondylar osteotomy for the treatment of cubitus varus in children:a systematic review[J].Bone Joint J,2014,96-B(5):691-700.DOI:10.1302/0301-620X.96B5.32296.
[9] Hasegawa M,Suzuki T,Kuroiwa T,et al.Reliability and validity of radiographic measurement of the humerus-elbow-wrist angle in healthy children[J].JB JS Open Access,2017,2(1):e0012.DOI:10.2106/JBJS.OA.16.00012.
[10] 冯硕.依据成角旋转中心原则行等腰三角形截骨治疗肘内翻畸形[D].重庆:重庆医科大学,2020.DOI:10.27674/d.cnki.gcyku.2020.000427. Feng S.Following the center of rotation of angulation isosceles triangular osteotomy treatment of cubitus varus deformity[D].Chongqing:Chongqing Medical University,2020.DOI:10.27674/d.cnki.gcyku.2020.000427.
[11] Modabber MR,Jupiter JB.Reconstruction for post-traumatic conditions of the elbow joint[J].J Bone Joint Surg Am,1995,77(9):1431-1446.DOI:10.2106/00004623-199509000-00021.
[12] Devnani AS.Late presentation of supracondylar fracture of the humerus in children[J].Clin Orthop Relat Res,2005,431:36-41.DOI:10.1097/01.blo.0000152439.43810.11.
[13] 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 humeral fracture with cubitus varus in children[J].Orthop J China,2016,24(24):2269-2273.DOI:10.3977/j.issn.1005-8478.2016.24.13.
[14] 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].J Bone Joint Surg Am,2010,92(7):1619-1626.DOI:10.2106/JBJS.I.00796.
[15] Devnani AS.Lateral closing wedge supracondylar osteotomy of humerus for post-traumatic cubitus varus in children[J].Injury,1997,28(9/10):643-647.DOI:10.1016/S0020-1383(97)00139-3.
[16] Bauer AS,Pham B,Lattanza LL.Surgical correction of cubitus varus[J].J Hand Surg Am,2016,41(3):447-452.DOI:10.1016/j.jhsa.2015.12.019.
[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] 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].J Shoulder Elbow Surg,2009,18(3):478-483.DOI:10.1016/j.jse.2009.02.007.
[19] Su Y,Nan G.Lateral closing isosceles triangular osteotomy for the treatment of a post-traumatic cubitus varus deformity in children[J].Bone Joint J,2016,98-B(11):1521-1525.DOI:10.1302/0301-620X.98B11.37890.
[20] Paley D,Herzenberg JE,Tetsworth K,et al.Deformity planning for frontal and sagittal plane corrective osteotomies[J].Orthop Clin North Am,1994,25(3):425-465.DOI:10.1016/S0030-5898(20)31927-1.
[21] Agrawal R,Agrawal RA,Kaul R,et al.Post-traumatic cubitus varus:long-term follow-up of corrective osteotomy using the Ilizarov method of compression distraction osteogenesis[J].J Pediatr Orthop B,2022,31(1):31-42.DOI:10.1097/BPB.0000000000000845.
[22] 徐明亮,董长红,蒋守海,等.肱骨髁上成角旋转中心微创截骨外固定治疗青少年肘内翻畸形[J].中国骨伤,2019,32(11):1044-1047.DOI:10.3969/j.issn.1003-0034.2019.11.013. Xu ML,Dong CH,Jiang SH,et al.Mini-invasive external fixation of humeral supracondylar angular rotation center for cubitus varus deformity in adolescents[J].Chin J Orthopa Trauma,2019,32(11):1044-1047.DOI:10.3969/j.issn.1003-0034.2019.11.013.
[23] Nordin M,Frankel VH.肌肉骨骼系统基础生物力学[M].邝适存,郭霞,译.第3版.北京:人民卫生出版社,2008. Nordin M,Frankel VH.Basic biomechanics of musculoskeletal system[M].Kuang SC,Guo X,translated.3rd Edition.Beijing:People’s Medical Publishing House,2008.
[24] Paley D.Orthopaedic principles[M].Beijing:China Medical Science Press,2005.
相似文献/References:
[1]吕秀敏陈珽范清沈品泉张菁.Salter骨盆截骨手术中髋臼骨块空间移位的模拟与分析[J].临床小儿外科杂志,2010,9(03):0.
LV Xiu-min,CHEN Ting,FAN Qing,et al.The simulation and analysis of the space moving bebind the acetabulum in Salter pelvic osteotomy.[J].Journal of Clinical Pediatric Surgery,2010,9(05):0.
[2]汪兵 王栋琪 苗武胜 姜海.改良Pauwels’股骨转子间截骨术治疗[J].临床小儿外科杂志,2011,10(05):375.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):375.
[3]孙庆增 史迎春 秦海辉 张凤飞. 双侧发育性髋关节脱位一期Salter骨盆截骨术[J].临床小儿外科杂志,2012,11(02):117.
[4]杨劼 张建立 王旺. 经前外侧入路髋臼周围三联截骨术在儿童髋关节疾病中的应用[J].临床小儿外科杂志,2012,11(03):171.
[J].Journal of Clinical Pediatric Surgery,2012,11(05):171.
[5]孙庆增 史迎春. 肘内侧小切口切开复位与闭合复位治疗儿童肱骨髁上骨折的疗效比较[J].临床小儿外科杂志,2014,13(03):191.
[6]孙庆增,史迎春..双侧同期Ｓａｌｔｅｒ骨盆截骨术治疗发育性双侧髋关节脱位的远期疗效观察[J].临床小儿外科杂志,2018,17(02):126.
Sun Qingzeng,Shi Yingchun..Longterm results of singlestage surgical treatment with Salter innominate osteotomy in developmental dysplasia of both hips.[J].Journal of Clinical Pediatric Surgery,2018,17(05):126.
[7]余京杭,李连永,张立军,等.股骨近端截骨在发育性髋关节发育不良手术治疗中的必要性研究[J].临床小儿外科杂志,2019,18(11):927.[doi:10.3969/j.issn.1671—6353.2019.11.007]
Yu Jinghang,Li Lianyong,Zhang Lijun,et al.Surgical necessity of proximal femoral osteotomy for developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,2019,18(05):927.[doi:10.3969/j.issn.1671—6353.2019.11.007]
[8]白云松,张学军,曹隽,等.3D打印模型在儿童先天性脊柱侧凸治疗中的应用研究[J].临床小儿外科杂志,2020,19(02):115.[doi:10.3969/j.issn.1671-6353.2020.02.005]
Bai Yunsong,Zhang Xuejun,Cao Jun,et al.Clinical efficacy of three-dimensional model in the surgical treatment of congenital scoliosis in children[J].Journal of Clinical Pediatric Surgery,2020,19(05):115.[doi:10.3969/j.issn.1671-6353.2020.02.005]
[9]姚子明,张学军,郭东,等.儿童先天性脊柱后凸畸形截骨方式的选择及效果分析[J].临床小儿外科杂志,2021,20(01):19.[doi:10.12260/lcxewkzz.2021.01.004]
Yao Ziming,Zhang Xuejun,Guo Dong,et al.Clinical outcomes and osteotomic strategies for congenital kyphosis in children[J].Journal of Clinical Pediatric Surgery,2021,20(05):19.[doi:10.12260/lcxewkzz.2021.01.004]
[10]端嘉骅,郑鹏飞,胡馨月,等.股骨近端截骨对2~3岁TonnisⅡ型发育性髋关节发育不良患者治疗效果的研究[J].临床小儿外科杂志,2021,20(02):172.[doi:10.12260/lcxewkzz.2021.02.012]
Duan Jiahua,Zheng Pengfei,Hu Xinyue,et al.Efficacy of femoral osteotomy for children aged 2-3 years with T?nnis Grade Ⅱ developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,2021,20(05):172.[doi:10.12260/lcxewkzz.2021.02.012]
备注/Memo
收稿日期:2022-5-17。
基金项目:海南省临床医学中心建设项目资助(QWYH202175)
通讯作者:甘先民,Email:13976093761@163.com