肘内翻与肘外翻.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2009-01-14,*,郑 炜 权,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2009-01-14,*,肘内翻与肘外翻,1,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,，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,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,2,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,3,图,1,4,fig.1-2:At follow-up.twelve years the patient had a cubitus varus of-20 degrees.,图,2,5,Fig.3:Cubitus varus deformity of the left elbow 34 months after treatment by closed reduction for a supracondylar fracture.,图,3,6,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,4,7,Fig.5:SUPRACONDYLAR OSTEOTOMY FOR CUBITUS VARUS,图,5,8,大家有疑问的，可以询问和交流,可以互相讨论下，但要小声点,9,肘外翻,图,6,10,此图摘自丁香园,图,7,11,肘外翻,图,8,12,Fig.8-10:At follow-up.twenty-eight years after injury.the patient had a cuhitus valgus of+35 degrees.,图,10,图,9,13,图,11,14,表,1,肘关节各角测量值,根据测量前臂外偏角正常为,165,0,170,0,，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,15,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,12,16,Fig.14:Cubitus varus of time right arm,18 degrees.Normal carryinig angle of the left arm,15 degrees.Correction necessary,33 degrees.,图,14,17,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 shown held open with bone grafts.,图,15,图,16,18,