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,2019,18(08):675-680,685.[doi:10.3969/j.issn.1671-6353.2019.08.012]
肱骨远端截骨Ilizarov矫形与单纯楔形截骨克氏针固定矫治术治疗儿童肘内翻的对比研究
- Title:
- 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
- 分类号:
- R683.41;R619
- 摘要:
- 目的 比较肱骨远端截骨Ilizarov矫形与单纯楔形截骨克氏针固定矫治术治疗儿童肘内翻的疗效及优缺点。方法 收集2008年5月至2017年5月收治的34例肘内翻患儿作为研究对象，其中经肱骨远端截骨Ilizarov矫形术治疗儿童肘内翻16例（A组），男童13例，女童3例，左侧9例，右侧7例，年龄（7.3±2.1）岁；单纯楔形截骨克氏针固定矫治术治疗儿童肘内翻18例（B组），男童12例，女童6例，左侧7例，右侧11例，年龄（8.2±1.9）岁。术前两组患儿一般资料具有可比性，术后对两组患儿进行了15个月至8年2个月的随访，平均随访39个月。对两组患儿术中各项指标、术后并发症及术后疗效进行比较，肘关节功能按改良的Flynn标准进行评价。结果 与肱骨远端截骨Ilizarov外固定术比较，单纯楔形截骨克氏针固定矫治术治疗肘内翻手术时间更短[（0.9±0.2）h vs.（1.8±0.3）h]，完全愈合时间更短[（28±4.5）d vs.（48.5±3.9）d]，拆内、外固定耗时更短[（31.4±5.7）min vs.（1±0.14）min）]，但手术切口更大[（3.8±1.1）cm vs.（1.5±0.9）cm]，术中出血量更多[（25.4±2.5）mL vs.（10.4±1.5）mL]，差异均有统计学意义（P<0.05）。肱骨远端截骨Ilizarov矫形组中有3例出现术后并发症，其中2例为神经挫伤，1例为针道感染，单纯楔形截骨克氏针固定矫治组中有4例术后出现尺神经挫伤，差异无统计学意义（χ2=0.062，P>0.05）；两组预后优良率分别为93.75%和94.4%，差异无统计学意义（χ2=0.007，P>0.05）。经肱骨远端截骨Ilizarov矫形术治疗，术前提携角肘内翻（15.2±2.4）°，术后提携角外翻（11.2±1.5）°。经单纯楔形截骨克氏针固定治疗，术前提携角为内翻（16.3±1.9）°，术后为提携角外翻（10.8±1.7）°。两组手术前后提携角的纠正有统计学意义（P<0.05）。结论 肱骨远端截骨Ilizarov矫形术和单纯楔形截骨克氏针固定矫治术治疗儿童肘内翻的临床疗效相同；Ilizarov外固定在外观瘢痕、外侧髁异常膨大方面有优势；但单纯截骨克氏针固定矫治术在手术时间、截骨完全愈合时间、取内固定耗时、术后护理等方面有优势。
- 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.
参考文献/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
相似文献/References:
[1]姜 海
汪 兵
吴永涛
苗武胜
吴 革.儿童肱骨远端骨骺分离的手术治疗[J].临床小儿外科杂志,2010,9(02):0.
Jiang hai,Wang bin,Wu yongtao,et al.The operative treatment in children’s distal humeral osteoepiphysis fracture.[J].Journal of Clinical Pediatric Surgery,2010,9(08):0.
[2]王琪.儿童髂前上棘骨折27例疗效分析[J].临床小儿外科杂志,2010,9(03):0.
[3]蒋欣 陈小亮 王道喜 唐学阳 刘利君. 儿童四肢长骨病理性骨折手术治疗60例[J].临床小儿外科杂志,2011,10(05):337.
[J].Journal of Clinical Pediatric Surgery,2011,10(08):337.
[4]邱继明,陈春华.弹性髓内针治疗儿童四肢长骨骨折33例[J].临床小儿外科杂志,2013,12(03):248.[doi:10.3969/j.issn.1671—6353.2013.03.028]
[5]赵艳君 陈海燕 陈纯. 应用SCL-90量表评估骨折患儿父母心理状况的调查研究[J].临床小儿外科杂志,2014,13(06):510.
[6]赵艳君,陈海燕,俞群,等. 以家庭为中心的整体干预模式对骨折患儿父母心理的影响[J].临床小儿外科杂志,2016,15(06):602.
[7]文玉伟,王强,宋宝健,等.应用单臂多功能外固定器治疗儿童病理性骨折[J].临床小儿外科杂志,2018,17(02):117.
Wen Yuwei,Wang Qiang,Song Baojian,et al.Application of unilateral multifunctional external fixator for treatment of pathological fracture in children.[J].Journal of Clinical Pediatric Surgery,2018,17(08):117.
[8]鲁明,杨征,尤海峰,等.超关节外固定架结合有限内固定手术治疗儿童型Pilon骨折的中期随访结局分析[J].临床小儿外科杂志,2019,18(07):594.[doi:10.3969/j.issn.1671-6353.2019.07.015]
Lu Ming,Yang Zheng,You Haifeng,et al.Midterm follow-up surgical outcomes of pediatric Pilon fracture[J].Journal of Clinical Pediatric Surgery,2019,18(08):594.[doi:10.3969/j.issn.1671-6353.2019.07.015]
[9]李海冰,叶文松,徐璐杰,等.儿童股骨近端良性骨肿瘤的手术治疗策略探讨[J].临床小儿外科杂志,2020,19(03):241.[doi:10.3969/j.issn.1671-6353.2020.03.010]
Li Haibing,Ye Wensong,Xu Lujie,et al.Treatment strategies for proximal femoral benign bone lesions in children[J].Journal of Clinical Pediatric Surgery,2020,19(08):241.[doi:10.3969/j.issn.1671-6353.2020.03.010]
[10]卢育南,林然,潘源城,等.闭合复位克氏针空心钉内固定治疗青少年肱骨髁间T型骨折的疗效分析[J].临床小儿外科杂志,2020,19(06):508.[doi:10.3969/j.issn.1671-6353.2020.06.009]
Lu Yunan,Lin Ran,Pan Yuancheng,et al.Treatment of T-type intercondylar humeral fractures with closed reduction K-wire and cannulated screw internal fixation[J].Journal of Clinical Pediatric Surgery,2020,19(08):508.[doi:10.3969/j.issn.1671-6353.2020.06.009]
备注/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）