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儿童肘内翻行外侧闭合楔形截骨术后的重塑

Remodeling after lateral closing-wedge osteotomy in children with cubitus varus.

作者信息

Lee Soon Chul, Shim Jong Sup, Sul Eun Jin, Seo Sung Wook

机构信息

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Seoul, Korea.

出版信息

Orthopedics. 2012 Jun;35(6):e823-8. doi: 10.3928/01477447-20120525-19.

Abstract

The purpose of this study was to evaluate the effectiveness of supracondylar lateral closing-wedge osteotomy of the humerus in children and the postoperative remodeling of the lateral condylar prominence. Lateral closing-wedge osteotomy for cubitus varus deformity was performed in 52 children. In all cases, medial translation for decreasing lateral condylar prominence or transposition of the ulnar nerve was not performed. Mean patient age was 8.8 years. Mean follow-up was 42 months. Clinical and radiological results were analyzed at last follow-up. Mean range of motion of the elbow in flexion and extension improved significantly (P<.05). Mean humeroulnar angle and mean shaft-condylar angle were significantly corrected (P<.05), and the angles between the affected and contralateral sides were not significantly different at last follow-up. Mean lateral condylar prominence index significantly decreased from 38.8% to 3.4%, and mean lateral condylar prominence amount decreased from -31.6% to -65.0% (P<.05 and P<.05, respectively). The amount of lateral condylar prominence remodeling was statistically correlated with the severity of preoperative cubitus varus, length of follow-up, and age at operation (P<.05 for all). The mean change in lateral condylar prominence amount in patients younger than 11 years (36.6%) was significantly greater than the mean change in lateral condylar prominence amount in patients aged 12 years or older (20.4%) (P=.001). Supracondylar lateral closing wedge osteotomy of the humerus is a simple and effective operation for correction of cubitus varus in children younger than 11 years with a considerable amount of lateral condylar prominence remodeling.

摘要

本研究的目的是评估儿童肱骨髁上外侧闭合楔形截骨术的有效性以及术后外侧髁突出的重塑情况。对52例儿童进行了用于肘内翻畸形的外侧闭合楔形截骨术。所有病例均未进行用于减少外侧髁突出的内侧移位或尺神经转位。患者平均年龄为8.8岁。平均随访时间为42个月。在末次随访时分析临床和影像学结果。肘关节屈伸平均活动范围显著改善(P<0.05)。平均肱尺角和平均骨干-髁角得到显著矫正(P<0.05),且在末次随访时患侧与对侧之间的角度无显著差异。平均外侧髁突出指数从38.8%显著降至3.4%,平均外侧髁突出量从-31.6%降至-65.0%(分别为P<0.05和P<0.05)。外侧髁突出重塑量与术前肘内翻严重程度、随访时间和手术年龄在统计学上相关(均为P<0.05)。11岁以下患者外侧髁突出量平均变化(36.6%)显著大于12岁及以上患者外侧髁突出量平均变化(20.4%)(P=0.001)。肱骨髁上外侧闭合楔形截骨术是矫正11岁以下伴有相当程度外侧髁突出重塑的儿童肘内翻的一种简单有效的手术方法。

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