Đánh giá kỹ thuật kết hợp xương có néo ép bên cột trụ ngoài trong đục xương sửa trục điều trị khuỷu vẹo trong ở trẻ em

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Tác giả: Đức Minh Mẫn Phan

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.176

Bộ sưu tập: Metadata

ID: 339403

Thêm vào giỏ Liên kết toàn văn

- Mục tiêu: Đánh giá hiệu quả của kỹ thuật đục xương sửa trục (ĐXST) cắt bỏ xương hình chêm theo đường mổ ngoài và kết hợp xương (KHX) bằng đinh Kirschner với chỉ thép néo ép bên cột trụ ngoài ở trẻ em có di chứng vẹo khuỷu vào trong và các biến chứng của kỹ thuật. - Đối tượng và phương pháp nghiên cứu: Hồi cứu mô tả những trường hợp trẻ em từ 7 tuổi đến 15 tuổi bị di chứng khuỷu vẹo trong do chấn thương đã được phẫu thuật tại khoa Chỉnh Hình Nhi BV.CTCH từ đầu năm 2018 đến hết 2019 theo phương pháp đục xương sửa trục cắt xương hình chêm và kết hợp xương trụ ngoài theo phương pháp xuyên đinh và néo chỉ thép số 8. - Kết quả: Trong 104 ca mổ một bên khuỷu gồm 63 khuỷu trái và 41 khuỷu phải, với 59 nam và 45 nữ, có tuổi trung bình 8,12 tuổi, 33,65% trường hợp vẹo nặng >
30 độ. Cấu hình kết hợp xương chủ yếu 2 đinh và chỉ thép có 89 ca, 3 đinh và chỉ thép có 15 ca. Thời gian theo dõi trung bình 6 tháng đến 2 năm với kết quả lành xương hết vẹo trong 100%, trong đó có 2 trường hợp bị tái phát do té ngã trước 3 tháng sau mổ và phải làm lại đều cho kết quả tốt, 9 trường hợp có ghi nhận hạn chế tầm vận động trước mổ và ghi nhận sau cùng chỉ còn 3 trường hợp còn hạn chế ít sau khi phẫu thuật. Ghi nhận bị lỏng đinh trồi ra da có 3 ca và bị nhiễm trùng chân đinh có 2 trường hợp. Thời gian rút dụng cụ từ sau 3 tháng đến thời điểm lâu nhất 20 tháng và trung bình 8 tháng. Kết quả chức năng theo Bellemore tốt có 94,2% khá 5,8% và xấu không có ca nào.- Kết luận: Kỹ thuật ĐXST cắt xương hình chêm với cấu hình kết hợp xương bằng đinh có chỉ thép néo ép cho kết quả rất hiệu quả và có thể cải thiện thêm tầm vận động chức năng gấp duỗi khuỷu sau mổ nếu có hạn chế trước đó.Abstract- Objective: To appreciate the effectiveness of lateral closing wedge osteotomy with tension - band wire fixation for treatment of traumatic cubitus varus deformity in children as well as the complications.- Methods: Describe retrospective the cases of children with age from 7 to 15 years old with cubitus varus due to trauma who underwent surgery at the Pediatric Orthopedic Department of HTO from the beginning of 2018 to the end of the year 2019 according to the method of lateral closing wedge osteotomy with 8 figure tension - band wire fixation on the outer column of the distal humerus.- Results: in 104 cases of surgery on one elbow, including 63 left elbows and 41 right elbows, 59 boys and 45 girls, with an average age of 8.12 years, 33.65% cases of severe varus >
30 degrees. The fixational configuration that combines mainly 2 situations, the first is 2 K-wire and steel thread in 89 cases, the second is 3 K-wire and steel thread in 15 cases. The average follow - up time was 6 months to 2 years with 100% bone healing and varus correcting results, including 2 cases of relapse due to falls during 3 months after surgery and had to be redone with good results. There were only 9 cases noted limited range of motion before surgery but only 3 cases with limited range of motion after surgery. There were 3 cases happening K-wire protruding under skin and 2 cases got infection. Instrument withdrawal time was from 3 months to the longest time of 20 months and an average of 8 months. Functional results according to Bellemore good 94.2%, good 5.8% and bad no cases.- Conclusion: The lateral closing wedge - shaped osteotomy technique combined with fixational configuration of the bones using the K-wire and 8 figure steel anchors has very effective results and can help further improve the range of motion of the elbow flexion and extension in situation of having the limitations before surgery. DOI: 10.59715/pntjmp.1.4.20

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