融合部旋转截骨金属接骨板固定治疗小儿先天性上尺桡关节融合

Therapeutic effects of derotation osteotomy of synostosis and fixation with steel plate on congenital radioulnar synostosis in children

目的介绍融合部旋转截骨金属接骨板固定治疗小儿先天性上尺桡关节融合术式的手术方法及疗效。方法回顾2016年1月至2019年12月收治的小儿先天性上尺桡关节融合Kienbock分型Ⅰ型患儿15例,男9例,女6例;年龄2~13岁,平均4岁9个月;双侧5例,单侧10例。均行融合部旋转截骨金属接骨板固定,术后不予石膏固定,辅以功能锻炼。随访期间行体格检查并给予影像学评价,随访时间4~40个月,平均18个月。结果15例患儿术前旋前畸形45°~102°,平均78.2°,术后达到优势侧旋前0°~20°,非优势侧中立位。所有患儿无上肢循环障碍,仅1例出现短暂的桡神经麻痹,但随访过程中逐渐恢复,无1例矫正度丢失及骨不连,虽然患儿旋转功能差,但前臂功能均有改善。结论此术式在治疗小儿先天性上尺桡关节融合中是一种简单、安全、有效的矫形方法。

Objective To investigate the surgical method and therapeutic effects of derotation osteotomy of synostosis and fixation with steel plate on congenital radioulnar synostosis in children.Methods A total 15 children patients with congenital radioulnar synostosis Kienbock typeⅠwho were treated in our hospital from January 2016 to December 2019 were enrolled in the study,including 9 males and 6 females,age range being 2~13yr,with mean age being 4 years and 9 months,of whom,there were 5 cases of bilateral lesion,and 10 cases of unilateral lesion.All the patients were treated by derotation osteotomy of synostosis and fixation with steel plate,without plaster fixation after operation,and who were assisted with functional exercises.The physical examination and imaging evaluation were performed during the follow-up,and the follow-up period ranged from 4 months to 40 months,with mean duration being 18 months.Results Befeore surgery the preoperative pronation was 45°~102°in 15 cases,mean 78.2°.After operation,the dominant lateral rotation reached 0°~20°and nondominant side to neutral position.There were no circulatory disturbance of upper limb in all the patients,only 1 case had transient radial nerve palsy,howevermwhich was gradually recovered during the follow-up,and no case of correction loss or nonunion.Although the patients had poor rotational function,the forearm function in all the patients was improved.Conclusion The operation method is a simple,safe and effective method in treatment of congenital radioulnar synostosis in children.