尺骨截骨并弹性悬吊固定术治疗尺骨撞击综合征

Combined ulnar shortening osteotomy and elastic suspended fixation in treatment of ulnar impaction syndrome

目的探讨尺骨截骨并弹性悬吊固定术治疗尺骨过长造成的尺骨撞击综合征疗效。方法 2015年10月—2016年8月,收治3例尺骨撞击综合征患者。男1例,女2例;年龄分别为32、29、59岁。1例为开放性尺桡骨骨折内固定术后1年余遗留远端尺桡关节脱位并撞击;余2例无明显外伤和手术史,但有长期腕关节劳动史。疼痛视觉模拟评分(VAS)分别为7、5、5分。Cooney腕关节功能评分均为差。术前X线片测量尺骨正向变异分别为12.7、9.0、8.7 mm。在尺骨横形截骨术并钢板螺钉内固定基础上,采用微型钢板弹性悬吊固定远端尺桡关节。结果术后X线片显示患肢远端尺桡关节匹配,与健侧相比无明显差异。患者切口均Ⅰ期愈合,无神经血管损伤、感染及远端尺桡关节脱位等并发症发生。3例患者均获随访,随访时间分别为27、17、23个月。末次随访时X线片示截骨段均骨性愈合,内固定物在位;VAS评分分别为2、0、1分,Cooney腕关节功能评分分别为80、100、90分,均为优。结论尺骨截骨并弹性悬吊固定术可以在纠正尺骨变异的同时,避免尺骨头周围组织广泛剥离造成的远端尺桡关节不稳,也避免刚性固定可能造成的关节僵硬,从而更好地治疗尺骨撞击综合征。

Objective To investigate the effectiveness of ulnar shortening osteotomy combined with elastic suspension fixation for ulnar impaction syndrome caused by relatively long ulna. Methods Between October 2015 and August 2016, 3 cases of ulnar impaction syndrome were treated. One patient was male and 2 patients were females. The age was 32, 29, and 59 years, respectively. One patient was dislocation and impaction of distal radioulnar joint for more than 1 year after internal fixation due to ulnar and radial open fractures. Other patients had no trauma and surgery, but long-term manual history. The visual analogue scale（VAS） scores were 7, 5, and 5, respectively. Cooney wrist function scores were rated as poor. Preoperative X-ray measurements of the ulnar variance was 12.7, 9.0, and 8.7 mm, respectively.The ulna was transversely osteotomy and fixed with plate and screws. The distal radioulnar joint was elastic suspension fixed with mini plate. Results Postoperative X-ray film showed that the matching of the distal radioulnar joint had no significant difference compared with the contralateral side. All the incisions healed by first intention without complication such as neurovascular injury, infection, and dislocation of the distal radioulnar joint. The patients were followed up 27, 17,and 23 months, respectively. At last follow-up, X-ray film showed that all osteotomy segments achieved bony union without internal fixation failure. The VAS scores were 2, 0, and 1, respectively, and the Cooney wrist function scores were rated as excellent. Conclusion The ulnar shortening osteotomy combined with elastic suspension fixation can correct the ulna variation, avoid the instability of the distal radioulnar joint caused by the extensive dissection of the tissue around the ulnar, and avoid stiffness of the joints caused by rigid fixation. It is an ideal treatment for ulna impaction syndrome.