儿童肘内翻畸形的矫正截骨术:一项前瞻性研究

A. Kotak, Suresh Rudani
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摘要

背景与目的:儿童肱骨远端髁上骨折后最常见的晚期并发症是肘内翻畸形,发生率从4%到58%不等。本研究的目的是评价穹窿截骨术的效果。材料和方法:本前瞻性研究在一家三级医院进行,为期16个月。所有患者均测量两侧肱骨-肘关节角,并计算所需矫正量。通过(AB-BC)/AC方法计算变形肘关节和正常肘关节完全伸展的正位片侧髁突出指数(LCPI)。采用肱旁入路穹窿截骨术。比较术前、术后肘关节负重角、关节活动度及侧突指数。结果:患者年龄3 ~ 15岁,平均年龄8.47±3.14岁。术前正常侧携带角为80 ~ 140,患侧携带角为-23 ~ -13,差异有统计学意义(p2.7%)。缺损侧携带角改善28.41±2.15,差异有统计学意义(p<0.05)。基线时LCPI均值为0.39±3.87%,变化为-0.86±3.47%,差异有统计学意义(p=0.01)。结论:穹窿截骨术是一种技术要求相对较高的矫正肘内翻畸形的技术,但在不伴有外侧髁突的情况下具有更好的功能结果。
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Corrective Osteotomy in cubitus varus deformity in children: A prospective study
Background and Aim: Cubitus varus deformity is the most common late complication aftersupracondylar fracture of the distal humerus in children, incidence varying from 4% to 58%. Thepresent study was done to evaluate the results of dome osteotomy. Material and Methods: Thisprospective study was conducted in a tertiary care hospital over 16 months. In all patients humerus-elbow wrist angle was measured on both sides and the correction needed was calculated. The lateralcondyle prominence index (LCPI) was calculated by anteroposterior view radiographs of thedeformed and the normal elbow in full extension by (AB-BC)/AC. Dome osteotomy with para tricepsapproach was used. Pre and post-operative carrying angle of elbow, range of motion and lateralprominence indices were compared. Results: The age of patients ranged from 3 to 15 years with amean age of 8.47±3.14 years. Preoperative carrying angle of normal side ranged from 80 to 140and that of effected side ranged from -23 to -13 and the difference was statistically significant(p<0.05). LCPI ranged from -8.4 to 5.9%. The majority of cases had LCPI >2.7%. As compared to,an improvement in carrying angle at defect side was observed to be 28.41±2.15 which wassignificant (p<0.05). At baseline mean LCPI was 0.39±3.87% which changed to -0.86±3.47%, themean change of this was significant (p=0.01). baseline Conclusion: Dome osteotomy is a relativelytechnically demanding technique for correction of cubitus varus deformity but with a betterfunctional outcome without being associated with lateral condyle prominence.
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