肘内翻与肘外翻__培训课件.pptVIP

郑 炜 权 郑 炜 权 2009-01-14 郑 炜 权 肘内翻与肘外翻 郑炜权 2009-01-14 2009-01-14 肘内翻与肘外翻 肘内翻或肘外翻是由于各种原因引起的肘部畸形。正常肘关节完全伸直时有一轻度外翻，男性约１０°，女性约１５°，这个外翻角称为携带角。若这个角度增大，即前臂过于外展，称为肘外翻畸形；若这个角度减少，甚至成了负角，就叫做肘内翻畸形 其病因主要为： (1)肱骨下端骨折畸形愈合 (2)由于外伤或感染造成外侧或内侧骨骺生长障碍 2009-01-14 临床表现 主要为肘部外观畸形，常没有症状 畸形严重者，可发生迟发性尺神经损伤 病程长者，可引起肘关节骨性关节炎 本病可发生于任何年龄，但以儿童多见，多以单侧为主，亦可见于双侧 本病轻度畸形者，不必作治疗。明显畸形或发生迟发性尺神经损伤，可考虑手术治疗，效果良好 2009-01-14 图1 2009-01-14 fig.1-2: At follow-up. twelve years the patient had a cubitus varus of -20 degrees. 图2 2009-01-14 Fig.3: Cubitus varus deformity of the left elbow 34 months after treatment by closed reduction for a supracondylar fracture. 图3 2009-01-14 Fig.4: Six weeks after French’s osteotomy there is good correction of the deformity. Note the periosteal reaction on the medial side of the humerus. 图4 2009-01-14 Fig.5: SUPRACONDYLAR OSTEOTOMY FOR CUBITUS VARUS 图5 2009-01-14 肘外翻 图6 2009-01-14 此图摘自丁香园 图7 2009-01-14 肘外翻 图8 2009-01-14 Fig.8-10: At follow-up. twenty-eight years after injury. the patient had a cuhitus valgus of + 35 degrees. 图10 图9 2009-01-14 图11 2009-01-14 表1 肘关节各角测量值 角 男 女 范围 平均 范围 平均 外偏角 1540~1780 1690 1580~1780 1670 携带角 20~160 110 20~220 130 肱角 770~950 850 720~910 830 尺角 740~990 840 720~930 880 根据测量前臂外偏角正常为1650~1700，小于此值为肘外翻，大于此值为肘内翻。亦有以其补角即携带角测量者 2009-01-14 Fig. 12: The upper extremities of a woman, aged fifty-five ears, with cubitus varus of the right elbow as the result of a fracture at time age of five. There is no disturbance of function, but she has always been “sensitive” about its appearance. Fig. 13: Medial tilting of the distal fragment caused by splinting the arm against the trunk (a). This may result in cubitus varus (b). 图13 图12 2009-01-14 Fig.14: Cubitus varus of time right arm, 18 degrees. Normal carryinig angle of the left arm, 15 degrees. Correction necessary, 33 degrees. 图14 2009-01-14 Fig. 15: Result one year afterward. Overcorrectioum about 5 degrees. Fig. 16: A postoperative roentgenogram to illustrate the placing of pins and clamp. The osteotomy is