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目的探讨儿童肱骨远端骨折致肘内翻形成的原因及机制,为手术矫正肘内翻提供临床参考。方法回顾性研究2009年1月至2014年2月,我科收治的肘内翻畸形患儿65例,男51例,女14例,年龄4~14岁,平均7.5岁;所有患儿均有明确的肱骨远端骨折病史,其中31例为肱骨髁上骨折,2例为肱骨外髁骨折,3例为肱骨内髁骨折,3例为肱骨远端全骨骺分离,26例具体骨折诊断不详。观察所有患儿的患侧肘关节正侧位X线片,与对侧肘关节或正常肘关节正侧位X线片比较,观察骨折愈合后残留的影像学痕迹及肱骨远端骨骺发育情况,测量肘内翻角度,观察肱骨内、外髁大小形态,尺骨鹰嘴窝、肱尺关节形态,滑车改变,肱骨头前倾角,骺板发育情况等。将骨折畸形愈合导致的肘内翻和肱骨远端内外侧骨骺生长发育不平衡导致的肘内翻分两类进行对比,分析肘内翻形成的原因及机制。结果 58例肘内翻主要因骨折畸形愈合所致,占89.2%,其中包括诊断明确的31例肱骨髁上骨折、2例为肱骨外髁骨折和2例肱骨远端全骨骺分离;7例肘内翻主要为肱骨远端内外侧骨骺生长发育不平衡所造成,包括3例肱骨内髁骨折和1例为肱骨远端全骨骺分离。结论临床上儿童肘内翻绝大部分由肱骨远端骨折后畸形愈合所致,但少部分可由肱骨远端骨骺生长发育不平衡所引起,在手术截骨矫正该类型的肘内翻时,需考虑到患儿的年龄及肘关节生长潜力,适度矫枉过正,提高治疗效果,减少术后复发率。
Objective To investigate the causes and mechanisms of cubitus varus in children with distal humerus fractures and to provide clinical reference for the correction of cubitus varus. Methods Retrospective study from January 2009 to February 2014, 65 cases of cubitus varus deformity were treated in our department, 51 males and 14 females, aged 4 to 14 years old, with an average of 7.5 years old; all children had A clear history of distal humeral fractures, of which 31 cases of supracondylar humerus fractures, 2 cases of humeral condyle fractures, 3 cases of humeral medial condylar fractures, 3 cases of distal humerus epiphyseal separation, 26 cases of specific fracture diagnosis is unknown. Observe the positive lateral radiographs of the affected elbows in all children and observe the residual imaging and the development of the distal humerus epiphysis after orthopedic fractures with the contralateral elbow or the normal lateral radiographs of normal elbow. Measurement of elbow varus angle, observe the size of the humerus, lateral condyle size, olecranon fossa ulnar, ulnar joint shape, pulley changes, humeral head anteversion, epiphyseal plate development and so on. To analyze the causes and mechanism of cubitus varus after comparing the elbow varus caused by unbalanced growth and development of elbow varus and distal epiphysis of the distal humerus. Results 58 cases of cubitus varus mainly due to fracture and malunion, accounting for 89.2%, including 31 cases of well-defined diagnosis of supracondylar humerus fractures, 2 cases of humeral lateral condyle fractures and 2 cases of distal epiphysis of the humerus; 7 cases of elbow Inverted mainly due to the development of the epiphyseal humerus distal medial and lateral growth and development caused by imbalance, including 3 cases of humeral medial condylar fractures and 1 case of distal humerus epiphyseal separation. Conclusion Clinically, the majority of cubitus varus in children is caused by malunion of the distal humerus fractures, but a small part of them may be caused by the unbalanced growth and development of epiphysis of the distal humerus. When the osteotomy of the genital tuberculum is correct, Taking into account the age of children and elbow joint growth potential, moderate overkill, improve the therapeutic effect and reduce postoperative recurrence rate.