Is distal ulna resection influential on outcomes of distal radius malunion corrective osteotomies?
Is distal ulna resection influential on outcomes of distal radius malunion corrective osteotomies?
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DOI：
10.1016/j.otsr.2011.03.022
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发表时间：
2011-09-01
影响因子：
2.3
通讯作者：
Chammas, M.
中科院分区：
文献类型：
--
作者：
Coulet, B.;El Ouali, M. Id;Chammas, M.
简介：桡骨远端畸形愈合对远端桡尺关节（DRU）的机械影响很常见，单独进行桡骨截骨术并不能一致地纠正。尺骨切除术因此成为一种姑息性的解决方案。假设：尺骨切除术是否影响桡骨远端畸形愈合矫正截骨术的结果？哪些术前因素需要保留远端桡尺关节？患者和方法：回顾性分析了21例桡骨矫正截骨术。在桡骨截骨术后出现软骨损伤、关节不一致或旋前持续僵硬的病例中，进行尺骨切除。结果：两组患者的截骨均愈合，桡骨骨骺的解剖恢复情况相似。我们注意到两种技术在截骨术后的活动度有统计学显著性增加（但它们之间没有差异），DRU+组对侧的握力为89.8%，而DRU组为90.4%。两组的疼痛（量表，0-3）均显著减轻，DRU+组从1.9降至0.3，DRU-组从2.5降至1.1，两组之间无显著差异。马约临床腕关节评分和DASH评分没有显着差异与73/100和13.5 DRU+组相比，68.2/100和20.2 DRU-group.Discussion：这些结果表明，尺骨切除后桡骨远端截骨术的影响是有限的，反映了放射校正，流动性和握力。然而，切除后，由于远端尺骨残端的不稳定性引起的手腕尺骨倾斜疼痛。除软骨损伤外，尺骨偏斜超过5 mm是导致DRU关节不能保留的一个恒定因素。证据等级：IV级。回顾性研究。(C)2011年Elsevier Masson SAS。All rights reserved.
Introduction: The mechanical repercussions of distal radius malunion on the distal radio-ulnar (DRU) joint are common and inconsistently corrected by radius osteotomy alone. Ulnar resection has thus become a palliative solution.Hypotheses: Does ulna resection influence the outcomes of distal radius malunion corrective osteotomies? What preoperative factors warrant preserving the distal radio-ulnar joint?Patients and methods: Twenty-one corrective osteotomies of the radius were retrospectively reviewed. Ulna resection was performed in cases of cartilage damage, joint incongruence, or persistent stiffness in pronosupination after osteotomy of the radius. After the osteotomies, two groups were identified: 10 cases with preservation of the distal end of the ulna (DRU+) and eleven with distal resections (DRU-).Results: At review, all the osteotomies had united, with comparable anatomical restoration of the radial epiphysisfor the two groups. We noted a statistically significant gain in mobility after osteotomy for both techniques (but no difference between them) and comparable grip strengths with 89.8% of the contralateral side for the DRU+ group versus 90.4% for the DRU-group. Pain (scale, 0-3) had significantly diminished for both groups decreasing from 1.9 to 0.3 for the DRU+ group and from 2.5 to 1.1 for the DRU-group, with no significant difference between them. The Mayo Clinic Wrist Score and the DASH score did not differ significantly with 73/100 and 13.5 for the DRU+ group compared with 68.2/100 and 20.2 for the DRU-group, respectively.Discussion: These results show that the impact of ulna resection after distal osteotomy of the radius is limited as reflected by radiological correction, mobility and grip strength. However, after resection pain in the ulnar tilt of the wrist due to instability of the distal ulnar stump was noted. Besides cartilage damage, ulnar deviation of over 5mm was, for this series, a constant factor in non-preservation of the DRU joint.Level of evidence: Level IV. Retrospective study. (C) 2011 Elsevier Masson SAS. All rights reserved.