镜下Wafer术与尺骨截骨治疗尺骨撞击综合征

Arthroscopic Wafer procedure versus open ulnar shortening osteotomy for ulnar impingement syndrome

[目的]比较腕关节镜下Wafer术与开放尺骨截骨治疗尺骨撞击综合征的临床疗效。[方法]2015年12月~2018年12月收治尺骨撞击综合征患者42例,随机分为两组。镜下组19例,行腕关节镜下清理+Wafer术;开放组23例,行开放尺骨干中远1/3斜形截骨。比较两组临床与影像结果。[结果]两组患者均顺利完成手术,镜下组手术时间显著长于开放组,镜下组术中出血量显著少于开放组(P<0.05)。两组患者随访12~16个月,平均(14.61±2.19)个月。镜下组患腕开始活动时间、完全负重时间均显著早于开放组(P<0.05)。随时间推移,两组患者VAS评分均显著减少(P<0.05),而握力、ROM和改良Mayo评分均显著增加(P<0.05)。术前及术后6个月,两组间上述指标差异无统计学意义(P>0.05),但术后3个月时,镜下组显著优于开放组(P<0.05)。影像方面,术前两组患者尺骨阳性变异量差异无统计学意义(P>0.05);术后两组患者的尺骨阳性变异均较术前显著减少(P<0.05);术后镜下组缩短幅度显著小于开放组(P<0.05)。术后两组患者的尺腕角均较术前显著减少(P<0.05);相应时间点,两组间尺腕角的差异均无统计学意义(P>0.05)。[结论]腕关节镜下清理联合Wafer术对尺骨阳性变异量的矫正小于尺骨截骨术,但两种术式均能显著改善患者术后临床症状和腕关节功能。

[Objective]To compare the clinical outcomes of arthroscopic Wafer procedure versus open ulnar shortening osteotomy for ulna impingement syndrome.[Method]From December 2015 to December 2018,42 patients with ulnar impingement syndrome were randomly divided into two group.Nineteen patients in the arthroscopic group received arthroscopic debridement combined with Wafer procedure,while 23 patients in the open group underwent open ulnar shortening osteotomy.The clinical consequences were compared between the two groups.[Results]All the patients in both group had surgical procedures performed smoothly with a significantly longer operation time,whereas a significantly less intraoperative blood loss in the arthroscopic group than the open group(P<0.05).The patients were followed up for 12~16 months with a mean of(14.61±2.19)months.The arthroscopic group restored active wrist motion and full-weight bearing activity significantly earlier than the open group(P<0.05).As time went,the VAS score significantly decreased,while the grip strength,wrist range of motion(ROM)and modified Mayor score significantly increased in both groups(P<0.05).Although there were no statistically significant differences in aforesaid items between the two groups before operation and at 6 months after operation(P>0.05),the arthroscopic group proved superior to the open group in VAS score,grip strength,ROM and modified Mayor score at 3 months postoperatively(P<0.05).With respect to radiographic assessment,the extent of positive ulnar variation significantly declined after operation in both groups compared those before operation in both group(P<0.05).Despite of no a statistical difference in positive ulnar variation between them before operation(P>0.05),the arthroscopic group got significantly less ulnar shortened than the open group after operation(P<0.05).In addition,the ulnocarpal angle significantly decreased postoperatively compared with those before operation in both groups(P<0.05),which were not significantly different between the two groups at any matching time point(P>0.05).[Conclusion]Although the arthroscopic debridement combined with wafer’s operation has less correction of positive ulnar variation than that of open ulna osteotomy,both therapies do significantly improve the clinical symptoms and wrist function.