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1、肘內翻與肘外翻鄭煒權2009-01-14鄭煒權肘內翻與肘外翻肘內翻或肘外翻是由于各種原因引起的肘部畸形。正常肘關節(jié)完全伸直時有一輕度外翻，男性約１０°，女性約１５°，這個外翻角稱為攜帶角。若這個角度增大，即前臂過于外展，稱為肘外翻畸形；若這個角度減少，甚至成了負角，就叫做肘內翻畸形其病因主要為：(1)肱骨下端骨折畸形愈合(2)由于外傷或感染造成外側或內側骨骺生長障礙2009-01-14臨床表現(xiàn)主要為肘部外觀畸形，常沒有癥狀畸形嚴重者，可發(fā)生遲發(fā)性尺神經(jīng)損傷病程長者，可引起肘關節(jié)骨性關節(jié)炎本病可發(fā)生于任何年齡，但以兒童多見，多以單側為主，亦可見于雙
2、側本病輕度畸形者，不必作治療。明顯畸形或發(fā)生遲發(fā)性尺神經(jīng)損傷，可考慮手術治療，效果良好2009-01-14圖12009-01-14fig.1-2:Atfollow-up.twelveyearsthepatienthadacubitusvarusof-20degrees.圖22009-01-14Fig.3:Cubitusvarusdeformityoftheleftelbow34monthsaftertreatmentbyclosedreductionforasupracondylarfracture.圖32009-01-14Fig.4:Sixwe
3、eksafterFrench’sosteotomythereisgoodcorrectionofthedeformity.Notetheperiostealreactiononthemedialsideofthehumerus.圖42009-01-14Fig.5:SUPRACONDYLAROSTEOTOMYFORCUBITUSVARUS圖52009-01-14肘外翻圖62009-01-14此圖摘自丁香園圖72009-01-14肘外翻圖82009-01-14Fig.8-10:Atfollow-up.twenty-eightyearsafterinj
4、ury.thepatienthadacuhitusvalgusof+35degrees.圖10圖92009-01-14圖112009-01-14表1肘關節(jié)各角測量值角男女范圍平均范圍平均外偏角1540~178016901580~17801670攜帶角20~16011020~220130肱角770~950850720~910830尺角740~990840720~930880根據(jù)測量前臂外偏角正常為1650~1700，小于此值為肘外翻，大于此值為肘內翻。亦有以其補角即攜帶角測量者2009-01-14Fig.12:Theupperextremities
5、ofawoman,agedfifty-fiveears,withcubitusvarusoftherightelbowastheresultofafractureattimeageoffive.Thereisnodisturbanceoffunction,butshehasalwaysbeen“sensitive”aboutitsappearance.Fig.13:Medialtiltingofthedistalfragmentcausedbysplintingthearmagainstthetrunk(a).Thismayresultincub
6、itusvarus(b).圖13圖122009-01-14Fig.14:Cubitusvarusoftimerightarm,18degrees.Normalcarryinigangleoftheleftarm,15degrees.Correctionnecessary,33degrees.圖142009-01-14Fig.15:Resultoneyearafterward.Overcorrectioumabout5degrees.Fig.16:Apostoperativeroentgenogramtoillustratetheplacingof
7、pinsandclamp.Theosteotomyisshownheldopenwithbonegrafts.圖15圖162009-01-14
