轨道支架尺骨延长在骨干续连症前臂畸形治疗中的应用

Application of ulna osteotomy and extending with orbit external fixator in the treatment of hereditary multiple exostoses forearm deformity

目的探讨和总结利用轨道外固定支架进行尺骨延长治疗骨干续连症中前臂畸形的临床经验。方法回顾性分析2002年8月至2012年12月,我院收治的具有完整资料的25例骨干续连症前臂畸形病例,男9例,女16例,年龄5~11岁,平均7.3岁,均采用尺骨截骨结合轨道外固定支架延长方法治疗。临床疗效根据肌肉骨骼肿瘤学会修改的功能评估量表评定。结果本组随访时间18~96个月,平均30.2个月。尺骨延长长度15~40 mm,平均28 mm,愈合时间3.5~8个月,平均5.2个月。根据肌肉骨骼肿瘤学会修改的功能评估量表进行评定,25例中优11例,良12例,可2例。结论利用轨道外固定支架及尺骨截骨延长治疗骨干续连症的前臂畸形,是一种安全有效的方法,能在不增加新的创伤情况下自动复位桡骨头,同时改善儿童肘关节屈伸、腕关节屈伸和尺桡偏活动及前臂旋转活动功能。

Objective To explore and summarize clinical experience of ulna osteotomy and extending with orbit external fixator in the treatment of hereditary multiple exostoses forearm deformity. Methods A total of 25 patients（ with complete data） of hereditary multiple exostoses forearm deformity underwent surgeries in our hospital from August, 2002 to December, 2012. Clinical data were retrospectively analyzed. Ulna osteotomy and gradual extending with orbit external fixator were applied. There were 9 males and 16 females with the average age of 7.3 years old（ range： 5-11 years）. Clinical results were assessed according to Gregory criteria. Results The average time of follow-up was 30.2 months（ range： 18-96 months）. The average length of ulna extending was 28mm（ range： 15-40 mm）. All patients healed on the average of 5.2 months（ range： 3.5-8 months）. According to Gregory criteria： excellent in 11 cases, good in 12 cases, fair in 2 cases. Conclusions The ulna osteotomy and extending with orbit external fixator in the treatment of hereditary multiple exostoses forearm deformity can spontaneously reduce the dislocation of the radial head without the need of any additional operative intervention. All patients are satisfied with final results. The elbow and wrist flexion / extension, wrist radial / ulnar-deviation, forearm pronation / supination are improved markedly compared with preoperative conditions.