肘内翻与肘外翻课件

肘内翻与肘外翻 郑炜权 郑 炜 权 肘内翻与肘外翻 n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，女性 约，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 n其病因主要为： n(1)肱骨下端骨折畸形愈合 n(2)由于外伤或感染造成外侧或内侧骨骺生长障碍 郑 炜 权 临床表现 n主要为肘部外观畸形，常没有症状 n畸形严重者，可发生迟发性尺神经损伤 n病程长者，可引起肘关节骨性关节炎 n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 n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 郑 炜 权 图1 郑 炜 权 fig.1-2: At follow-up. twelve years the patient had a cubitus varus of -20 degrees. 图2 郑 炜 权 Fig.3: Cubitus varus deformity of the left elbow 34 months after treatment by closed reduction for a supracondylar fracture. 图3 郑 炜 权 Fig.4: Six weeks after Frenchs osteotomy there is good correction of the deformity. Note the periosteal reaction on the medial side of the humerus. 图4 郑 炜 权 Fig.5: SUPRACONDYLAR OSTEOTOMY FOR CUBITUS VARUS 图5 郑 炜 权 肘外翻 图6 郑 炜 权 此图摘自丁香园 图7 郑 炜 权 肘外翻 图8 郑 炜 权 Fig.8-10: At follow-up. twenty-eight years after injury. the patient had a cuhitus valgus of + 35 degrees. 图10 图9 郑 炜 权 图11 郑 炜 权 表1 肘关节各角测量值 角男女 范围平均范围平均 外偏角154017801690158017801670 携带角2016011020220130 肱角770950850720910830 尺角740990840720930880 根据测量前臂外偏角正常为16501700，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 郑 炜 权 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 郑 炜 权 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 郑 炜 权 Fig. 15: Result one year afterward. Overcorrectioum about 5 degrees. Fig. 16: A postoperative roentgenogram to illus