Liddell Travis R, Hennrikus William L, Bresnahan James J
*CORE Orthopaedics, Avera Medical Group, Sioux Falls, SD; and †Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Hershey, PA.
J Orthop Trauma. 2016 Oct;30(10):e340-5. doi: 10.1097/BOT.0000000000000591.
To report the outcomes when performing a dual-planar osteotomy of the distal humerus via a posterior approach for gunstock deformity in children.
A retrospective review.
Penn State Hershey Pediatric Bone and Joint Institute.
PATIENTS/PARTICIPANTS: Sixteen patients were reviewed. The average patient age was 8 years (range, 5-13 years).
A complete dual-planar closing wedge osteotomy was performed with the patient in the prone position via a posterior triceps-splitting approach. Fixation with buried smooth K wires was utilized.
Valgus correction obtained, final elbow range of motion, radiographic and clinical correction of the deformity, the patient's satisfaction, and elbow function were evaluated.
Preoperative radiographs showed the average humeral-ulnar angle (HUA) was 17 degrees of varus (range, 10-26 degrees varus). The average wedge removed wallow-up clinical exam demonstrated that the carrying angle was in valgus in 15 cases and neutral in 1 case. The average carrying angle was 5 degrees of valgus (range, 0-11 degrees valgus). The average hyperextenss 25 degrees (range, 20-40 degrees). Duration of follow-up averaged 51 months (range, 12-126 months). Final foion deformity improved from 9 degrees preoperatively to 1 degree postoperatively. Outcomes were classified by the grading scale described by Oppenheim: 14 cases had excellent results and 2 cases had good results.
This method provides clear visualization and excellent correction of the deformities. The posterior scar is cosmetically acceptable. We recommend this technique for the treatment of gunstock deformity in children.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
报告经后路行双平面肱骨远端截骨术治疗儿童枪托样畸形的疗效。
回顾性研究。
宾夕法尼亚州立大学赫尔希儿科骨与关节研究所。
患者/参与者：对16例患者进行了回顾性研究。患者平均年龄为8岁（范围5 - 13岁）。
患者俯卧位，经后路三头肌劈开入路行完全双平面闭合楔形截骨术。采用埋头光滑克氏针固定。
评估获得的外翻矫正、最终肘关节活动范围、畸形的影像学和临床矫正情况、患者满意度及肘关节功能。
术前X线片显示平均肱尺角（HUA）为内翻17°（范围10° - 26°内翻）。平均截除楔形骨块……随访时临床检查显示，15例患者提携角为外翻，1例为中立位。平均提携角为外翻5°（范围0° - 11°外翻）。平均过伸25°（范围20° - 40°）。随访时间平均为51个月（范围12 - 126个月）。最终畸形从术前的9°改善至术后的1°。结果根据奥本海姆描述的分级标准进行分类：14例结果为优，2例为良。
该方法能清晰显露并出色矫正畸形。后侧瘢痕在美容上可接受。我们推荐该技术用于治疗儿童枪托样畸形。
治疗性四级证据。有关证据级别的完整描述见作者指南。 （原文此处“平均截除楔形骨块wallow-up”可能有误，未准确翻译该词）
