融合截骨联合尺桡骨双截骨治疗先天性桡尺近侧关节融合

Application of fusion site osteotomy combined with ulna and radius osteotomy for the treatment of congenital proximal radioulnar synostosis

目的探讨先天性桡尺近侧关节融合的临床特点及手术治疗。方法我院自2014年5月至2017年5月收治9例先天性橈尺近侧关节融合患者,通过术前X线、前臂外形、前臂旋转功能、肘关节屈伸功能检查,观察橈骨小头、尺橈骨融合及发育情况,对其进行分型,采用融合截骨、尺骨截骨、橈骨截骨、骨间膜松解、环状韧带重建手术等。结果9例患者共14侧进行手术,随访3~38个月,平均17个月,均未出现再度融合,前臂的外形和旋转功能均得到良好的改善。肘关节功能采用Mayo评分:优7侧,良5侧,可2侧。结论先天性桡尺近侧关节融合严重影响患儿生活质量,采用融合部位截骨联合尺桡骨双截骨手术可以获得良好的治疗效果。

Objective To explore the clinical features and surgical treatment of congenital proximal radioulnar synostosis. Methods From May 2014 to May 2017, 9 cases of congenital proximal radioulnar synostosis were treated in our hospital. By preoperative X-ray examination, forearm shape, forearm rotation function, elbow flexion and extension function, the fusion and development of radial head, ulna and radius were observed and classified. The operations including fusion site osteotomy, ulna osteotomy, radius osteotomy, interosseous membrane release and circular ligament reconstruction were performed. Results Nine patients performed operation on 14 sides were follow-up for 3 to 38 months with an average of 17 months. No re-synostosis occurred, and the shape and rotation function of the forearm were improved. The elbow function was evaluated by Mayo score, and the results were excellent in 7 sides, good in 5 sides and fair in 2 sides. Conclusion Congenital proximal radioulnar synostosis seriously affects the quality of life of children, and the fusion site osteotomy combined with ulna and radius osteotomy can achieve good treatment outcomes.