Burnei G, Gavriliu Ş, Nepaliuc I, Vlad C, Drăgoescu M, Georgescu I, Ghita R A, Muntean L, Pârvan A A, Dughilă C, Ţiripa I, Hamei Ş, Klinaku I
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; "Maria Sklodowska Curie" Children's Clinical Emergency Hospital, Bucharest, Romania ; The Studies and Research Group in Pediatric Orthopedics-2012.
"Nicolae Testemiţeanu" State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
J Med Life. 2014 Oct-Dec;7(4):595-600.
Supracondylar fractures of the humerus represent a current concern in the child's and adolescent's osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in "Prof. Dr. Alexandru Pesamosca" Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion. Varus or valgus deformations were rarely encountered after surgical treatment. The goal of this study is to present an alternative surgical technique to correct varus and valgus deformations as well as malrotation.
The study is a retrospective analysis of a 96 children study group surgically managed during 1985 and 2013. In the first period, various surgical techniques have been performed: cuneiform resections, step-cut osteotomies, open wedge osteotomies with external fixation, epiphysiodesis, hemichondrodiatasis and Pesamosca metaphyseal diaphyseal osteoplasty. Starting with 2005, all the cases that presented such complications--28 out of 96 (29.1%)--were managed with the Pesamosca procedure. Due to the malunion of supracondylar humeral fractures only varus or valgus deformities were admitted in the study. The malunion due to the pathologic fractures encountered in osteogenesis imperfecta or fibrous dysplasia was precluded. The experience accumulated with the other surgical techniques used in 68 out of 96 patients (70.9%) determined us to exclusively use the Pesamosca osteoplasty following the year 2005, seeing the simplicity and the efficiency of this procedure.
The outcome was very good. In 5 cases out of the 28 (17%) an apparent residual elbow was encountered and one case of relapse (3%) was noted due to inadequate term of cast immobilization. The elbow's mobility was completely recovered, the thoracic member's axis was appropriate and the metaphyseal diaphyseal osteotomy site healed completely in 3 months' time.
Compared to other surgical techniques, the Pesamosca technique offers to the surgeon the possibility of correcting the varus or the valgus deformity as well as the malrotation in a simple, secure and efficient manner.
肱骨髁上骨折是儿童和青少年骨与关节病理学中的一个当前关注点。尽管骨科复位操作正确，但仅通过石膏固定治疗时骨折仍可能移位，并可能出现并发症。在罗马尼亚布加勒斯特的“亚历山德鲁·佩萨莫斯卡教授博士”诊所，由于肱骨髁上骨折最常遇到的并发症是畸形愈合导致的外翻或内翻畸形，其角度有时可超过40度。手术治疗后很少遇到内翻或外翻畸形。本研究的目的是提出一种替代手术技术，以纠正内翻和外翻畸形以及旋转不良。
本研究是对1985年至2013年期间接受手术治疗的96名儿童研究组的回顾性分析。在第一阶段，采用了各种手术技术：楔形切除术、阶梯状截骨术、带外固定的开放楔形截骨术、骨骺阻滞术、半软骨扩张术和佩萨莫斯卡干骺端骨干骨成形术。从2005年开始，所有出现此类并发症的病例——96例中的28例（29.1%）——均采用佩萨莫斯卡手术进行治疗。由于肱骨髁上骨折的畸形愈合，本研究仅纳入内翻或外翻畸形。排除了成骨不全或纤维发育不良中病理性骨折导致的畸形愈合。96例患者中的68例（70.9%）使用其他手术技术积累的经验使我们在2005年后仅使用佩萨莫斯卡骨成形术，因为该手术简单且有效。
结果非常好。28例中有5例（17%）出现明显的残留肘部问题，1例（3%）因石膏固定时间不足出现复发。肘部活动完全恢复，上肢轴线正常，干骺端骨干截骨部位在3个月内完全愈合。
与其他手术技术相比，佩萨莫斯卡技术为外科医生提供了以简单、安全和有效的方式纠正内翻或外翻畸形以及旋转不良的可能性。
