Okpara Shawn O, Wilson Philip L, Jo Chan-Hee, Ho Christine A
Baylor College of Medicine, Department of Orthopedic Surgery, Houston, TX, USA.
Department of Orthopaedic Surgery, Scottish Rite for Children, Dallas, TX, USA.
J Pediatr Soc North Am. 2024 Feb 28;6:100022. doi: 10.1016/j.jposna.2024.100022. eCollection 2024 Feb.
While pediatric cubitus varus has often been considered merely a cosmetic deformity, long-standing cubitus varus can lead to symptomatic pain and elbow instability in adults and may present as early as adolescence. The purpose of this study was to compare patient and radiographic characteristics, surgical factors, and symptom resolution after distal humeral osteotomy for cubitus varus in pediatric versus adolescent patients.
This is a retrospective single-institution review of 17 patients (12 patients <10.0 years (group Peds); 5 patients >10.0 years (group Adol)) were treated for cubitus varus with distal humeral osteotomy from 2003 to 2019. Peds had a median age of 6.3 years (range, 2.7-7.8 years) at the time of osteotomy, and Adol had a median age of 14.1 years (range, 13.5-16.7 years). A Fisher's exact test was used to compare categorical variables between Peds and Adol, and continuous variables were compared using Mann-Whitney or Student's t-test depending on normality results using the Shapiro-Wilk test. Statistical significance was set at .
Preoperative pain was present in 17% (2/12) of Pediatric patients (Peds) but 100% (5/5) of Adolescent patients (Adols). Mechanical symptoms were present in 17% (2/12) of Peds and 80% (4/5) in Adol. Radiographic correction and final range of motion did not significantly differ between the 2 groups. The mean tourniquet time was 83 minutes in Peds and 117 minutes in Adol. Pin fixation was used in 100% (12/12) of Peds; 80% (4/5) of Adol had plates. At the final follow-up, all Peds had resolution of symptoms, but 60% (3/5) Adol had continued pain and mechanical symptoms.
Although both pediatric and adolescent patients have similar radiographic correction and range of motion after distal humeral osteotomy to correct cubitus varus, the surgery may be more technically difficult in adolescent patients, with longer tourniquet times and the use of plate instead of pin fixation. Adolescents should be counseled that, like adults, their symptoms may not completely resolve after correction of radiographic and clinical deformity. The authors recommend that cubitus varus be corrected in childhood prior to the development of symptoms in adolescence.
1)Cubitus varus following pediatric distal humerus fracture may present with pain and mechanical symptoms as early as adolescence.2)Although pediatric and adolescent patients may have similar radiographic correction and range of motion after distal humeral osteotomy, the surgery is technically more difficult in adolescent patients.3)Adolescents should be counseled that pre-operative symptoms may not completely resolve after correction of radiographic and clinical limb deformity.4)It is the authors' opinion that cubitus varus should be surgically corrected before a child reaches adolescence, when it is technically less demanding and before mechanical symptoms and pain develop.
Level III - Retrospective Cohort Study.
虽然小儿肘内翻常常仅被视为一种外观畸形，但长期存在的肘内翻可导致成人出现症状性疼痛和肘关节不稳定，且可能早在青春期就出现。本研究的目的是比较小儿与青少年患者因肘内翻行肱骨远端截骨术后的患者及影像学特征、手术因素和症状缓解情况。
这是一项对17例患者的回顾性单机构研究（12例患者年龄<10.0岁（小儿组）；5例患者年龄>10.0岁（青少年组）），这些患者在2003年至2019年期间因肘内翻接受了肱骨远端截骨术。小儿组患者截骨时的中位年龄为6.3岁（范围2.7 - 7.8岁），青少年组患者的中位年龄为14.1岁（范围13.5 - 16.7岁）。采用Fisher精确检验比较小儿组和青少年组之间的分类变量，根据Shapiro-Wilk检验的正态性结果，使用Mann-Whitney检验或Student t检验比较连续变量。设定统计学显著性水平为 。
小儿患者（小儿组）中17%（2/12）术前存在疼痛，但青少年患者（青少年组）中100%（5/5）术前存在疼痛。小儿组中17%（2/12）存在机械性症状，青少年组中80%（4/5）存在机械性症状。两组之间的影像学矫正和最终活动范围无显著差异。小儿组的平均止血带时间为83分钟，青少年组为117分钟。小儿组100%（12/12）使用了克氏针固定；青少年组80%（4/5）使用了钢板。在末次随访时，所有小儿组患者症状均缓解，但青少年组60%（3/5）仍有持续疼痛和机械性症状。
尽管小儿和青少年患者在因肘内翻行肱骨远端截骨术后有相似的影像学矫正和活动范围，但青少年患者的手术在技术上可能更困难，止血带时间更长，且使用钢板而非克氏针固定。应告知青少年，与成人一样，在影像学和临床畸形矫正后，他们的症状可能不会完全缓解。作者建议在儿童期出现青春期症状之前矫正肘内翻。
1）小儿肱骨远端骨折后的肘内翻可能早在青春期就出现疼痛和机械性症状。2）尽管小儿和青少年患者在肱骨远端截骨术后可能有相似的影像学矫正和活动范围，但青少年患者的手术在技术上更困难。3）应告知青少年，术前症状在影像学和临床肢体畸形矫正后可能不会完全缓解。4）作者认为，应在儿童进入青春期之前对肘内翻进行手术矫正，此时技术要求较低，且在机械性症状和疼痛出现之前。
III级——回顾性队列研究。
