本文選題：肘內(nèi)翻 + 等腰三角形截骨�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的肘內(nèi)翻畸形(Cubitus varus,CV),是指肘關(guān)節(jié)正常的攜帶角消失,前臂向內(nèi)發(fā)生旋轉(zhuǎn),從而產(chǎn)生了肘關(guān)節(jié)外觀和正常解剖關(guān)系的改變。目前兒童肘內(nèi)翻的治療方案眾多,主要體現(xiàn)在肱骨截骨方式的多樣性。目前主要的截骨方式有肱骨遠端楔形截骨、梯形截骨、弧頂狀截骨等。各種方法雖然優(yōu)點顯著,但也存在明顯的缺點,最常見的不足表現(xiàn)為肱骨遠端截骨后外側(cè)骨性的凸起所導(dǎo)致外觀缺陷、手術(shù)設(shè)計復(fù)雜、操作困難無法普及等,針對以上不足,我們設(shè)計出等腰三角形截骨矯形術(shù),該種方法理論上可以較好地彌補傳統(tǒng)截骨方式的不足,所以本文將探討應(yīng)用肱骨遠端等腰三角形截骨術(shù)治療兒童肘內(nèi)翻的適宜性及優(yōu)缺點。方法選取2010年2月1日至2013年12月31日在本院診斷為肘內(nèi)翻畸形患兒25例,其中男性患兒15例,女性患兒10例,患兒年齡區(qū)間為5~12歲,平均年齡9.5歲。手術(shù)方法均為采用肱骨遠端等腰三角形截骨術(shù),內(nèi)固定均選擇克氏針固定。所有患兒術(shù)前均進行患側(cè)與健側(cè)的肘關(guān)節(jié)正側(cè)位X線檢查,并測量患側(cè)內(nèi)翻角與健側(cè)的提攜角,根據(jù)患側(cè)的內(nèi)翻角與健側(cè)的提攜角計算出截骨三角塊頂角的角度,從而設(shè)計截骨線。術(shù)中均采用外側(cè)小切口入路,暴露肱骨遠端鷹嘴窩及冠狀窩頂點,根據(jù)術(shù)前設(shè)計的等腰三角形截骨角度及截骨線進行肱骨截骨,尺側(cè)皮質(zhì)不用鋸斷,起到鉸鏈的作用,主刀固定肱骨近端,在助手幫助下將前臂向外側(cè)外展,閉合截骨面后再利用預(yù)先留置的克氏針進行內(nèi)固定,術(shù)后石膏固定3-4周。結(jié)果25例均獲得隨訪,隨訪時間6~32月,平均16個月,術(shù)后病例無明顯切口感染病例,出現(xiàn)3例針道輕微感染,換藥后自愈,無骨愈合延遲;未發(fā)生尺神經(jīng)炎病例;所有患兒肘內(nèi)翻畸形外觀均得到了矯正,符合生理,肘部無疼痛病例,肘關(guān)節(jié)功能均達到優(yōu)良。結(jié)論肱骨遠端等腰三角形楔形截骨術(shù)對于矯正兒童肘內(nèi)翻畸形是一個非常實用、有效、可靠、安全、簡單的方案,可以有效的解決外側(cè)髁骨性突起和截骨處不穩(wěn)定的問題,本方法并發(fā)癥少,術(shù)后外形美觀,功能良好,是值得推廣的一種手術(shù)方案。
[Abstract]:Objective cubital varus is a cubital joint whose normal carrying angle disappears and the forearm rotates inward, which results in the appearance and normal anatomic relationship of the elbow. At present, there are many treatments for cubitus varus in children, mainly reflected in the diversity of humeral osteotomy. At present, the main osteotomy methods are wedge-shaped distal humerus osteotomy, trapezoid osteotomy, arcuate osteotomy and so on. Although the advantages of various methods are significant, they also have obvious shortcomings. The most common shortcomings are the appearance defects caused by the protrusions of the posterolateral bone of distal humeral osteotomy, the complexity of the operation design, the difficulty of operation, and so on. We designed the isosceles triangle osteotomy orthopedics, this method can make up the deficiency of the traditional osteotomy in theory, so this article will discuss the appropriateness, advantage and disadvantage of using the distal humerus triangle osteotomy to treat the cubitus varus in children. Methods from February 1, 2010 to December 31, 2013, 25 cases of cubitus varus malformation were diagnosed in our hospital. Among them, 15 cases were male and 10 cases were female. The age range of the children was 512 years old with an average age of 9.5 years. All the surgical methods were performed by isosceles triangle osteotomy of distal humerus, and Kirschner's needle was used for internal fixation. All the children were examined by X ray before operation, and the angle of the angle between the affected side and the healthy side was measured. According to the angle of the affected side and the healthy side, the angle of the apex angle of the osteotomy triangle block was calculated according to the angle of the side of the affected side and the healthy side of the elbow joint, and the angle of the angle was calculated according to the angle of the affected side and the healthy side. Thus the osteotomy line is designed. The lateral small incision approach was used to expose the vertices of the olecranon fossa and the coronal fossa of the distal humerus. According to the angle and line of isosceles triangle osteotomy designed before operation, humerus osteotomy was carried out, and the ulnar cortex did not need to be sawed. The proximal humerus was fixed with the main knife and the forearm was outreaching with the help of assistant. After closing the osteotomy surface, the internal fixation was performed with pre-indwelling Kirschner needle, and the plaster fixation was done for 3-4 weeks after operation. Results all the 25 cases were followed up for 632 months (mean 16 months). There were no obvious incision infection cases, 3 cases had slight infection of needle path, no bone union was delayed and no ulnar neuritis occurred. The appearance of cubitus varus deformity was corrected in all children, and the function of elbow joint was excellent. Conclusion the isosceles triangle wedge osteotomy of distal humerus is a practical, effective, reliable, safe and simple method for correction of cubitus varus deformity in children. It can effectively solve the instability of lateral condylar process and osteotomy. This method has few complications, beautiful appearance and good function. It is worth popularizing.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.8

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