改良反向Sauvé-Kapandji术治疗先天性上尺桡融合的早期疗效

The short-term outcomes of congenital radioulnar synostosis patients treated with modified reverse Sauvé-Kapandji technique

目的评估改良反向Sauvé-Kapandji术治疗先天性上尺桡融合的早期效果。方法回顾性分析2018年12月至2020年1月北京积水潭医院手外科采用改良反向Sauvé-Kapandji术治疗并获得随访的46例(54侧)先天性上尺桡融合患者,男38例(45侧)、女8例(9侧),年龄6.6(3.2,8.1)岁;均为Cleary-OmerⅢ型。采用改良反向Sauvé-Kapandji术治疗,即于桡骨近端截除1~1.5 cm长的骨干,使用异体肌腱填塞,并在尺骨中段横行截断骨干,矫正横断面旋转畸形,根据尺骨髓腔情况采用髓内针或克氏针固定。术前及末次随访时评估患者影像学表现,记录改良Morrey tasks评分、主观功能评分、无代偿前臂旋转角度、腕关节代偿后前臂旋转角度、腕及肩关节同时代偿后前臂旋转角度。结果所有46例患者均获得随访,随访时间(14.6±3.4)个月(范围11.2~19.5个月)。术前无代偿前臂旋转角度为0.0°±0.0°、术后为62.3°±23.7°,腕关节代偿后手术前后前臂旋转角度分别为86.9°±29.4°和133.2°±27.9°,腕及肩关节同时代偿后手术前后前臂旋转角度为205.2°±42.7°和245.2°±35.8°,手术前后的差异均有统计学意义(t=8.71,P<0.001;t=2.54,P=0.030;t=5.05,P<0.001)。术后31例(37侧)患者尺骨愈合,愈合时间为(6.1±2.3)个月;15例(17侧)骨折延迟愈合,经支具固定及骨科冲击波等治疗后获得愈合,愈合时间为(8.4±1.6)个月。43侧术后假关节清晰患者主观功能评分及改良Morrey tasks评分分别为12.1(0.0,20.8)分和0.7(0.0,1.0)分,均较术前33.9(25.0,41.6)分和3.2(2.0,4.0)分改善,差异有统计学意义(Z=-2.44,P=0.015;Z=-2.83,P=0.005);11侧桡骨假关节再融合者,无代偿旋转角度为11.4°±10.5°(范围0°~30°)、腕关节代偿后旋转角度为98.6°±15.9°(范围80°~120°)、腕及肩关节代偿后旋转角度为231.7°±16.9°(范围210°~255°)、主观功能评分为26.7(8.3,39.6)分、改良Morrey tasks评分为1.2(0,2)分。术后发生桡神经麻痹者2例,未作特殊处理于术后3个月症状改善。结论改良反向Sauvé-Kapandji术可用于治疗先天性上尺桡融合,术后短期疗效满意。

Objective To evaluate the short-term outcomes of modified reverse Sauvé-Kapandji technique in treating the congenital radioulnar synostosis.Methods A retrospective analysis was performed on the data of 46 congenital radioulnar synostosis patients were treated with modified reverse Sauvé-Kapandji technique in Beijing Jishuitan Hospital from December 2018 to January 2020,including 38 males(45 sides),8 females(9 sides),average age 6.6(3.2,8.1)years old.All the patients were classified as typeⅢaccording to Cleary-Omer classification and were followed up for at least 1 year.All the patients were treated with same operation,in which 1.5 cm shaft was resected at the proximal radius,allogeneic graft tendon was used as interposition,and rotational osteotomy was performed in the middle of the ulnar shaft,with intramedullary needle or Kirschner wire fixation,depending on the intramedullary width of ulnar shaft.The radiological features were collected and recorded preoperatively and at the latest follow-up,together with the following evaluation indexes:modified Morrey tasks score,subjective function score,active forearm rotation range without compensation,active forearm rotation range with wrist joint compensation,and active forearm rotation range with wrist and shoulder joint compensation.Results All patients were followed up for 14.6±3.4 months(range,11.2-19.5 months).The uncompensated forearm rotation Angle was 0.0°±0.0°before surgery and 62.3°±23.7°after surgery.The forearm rotation angles before and after surgery with wrist compensatory surgery were 86.9°±29.4°and 133.2°±27.9°,respectively.The forearm rotation angles before and after surgery with wrist and shoulder joint compensatory surgery were 205.2°±42.7°and 245.2°±35.8°,respectively.There were statistically significant differences in the above indexes before and after surgery(t=8.71,P<0.001;t=2.54,P=0.030;t=5.05,P<0.001).Ulnar union was observed in 31 patients(37 sides)after the operation,and the union duration was 6.1±2.3 months.There were 15 patients(17 sides)ulnar shafts faced with postoperative delayed union,the union duration was 8.4±1.6 months and were recovered after prolonging brace fixation and orthopedic shock wave treatment.The scores of subjective function and improved Morrey tasks of the 43 sides with good pseudo-joint were 12.1(0.0,20.8)and 0.7(0.0,1.0)points,respectively,which were improved compared with 33.9(25.0,41.6)and 3.2(2.0,4.0)points before surgery.The differences were statistically significant(Z=-2.44,P=0.015;Z=-2.83,P=0.005).There were 11 forearms with postoperative pseudo-joint re-ankylosis,the average forearm rotation ranges without compensation was 11.4°±10.5°(range,0°-30°),the average forearm rotation ranges with wrist compensation was 98.6°±15.9°(range,80°-120°),the average forearm rotation ranges with wrist and shoulder compensation was 231.7°±16.9°(range,210°-255°).The average subjective function scores was 26.7(8.3,39.6).The average modified Morrey tasks scores was 1.2(0,2),and there were no other postoperative complications.Conclusion The reverse Sauvé-Kapandji technique showed a satisfying short-term outcome,and can be a new choice of treatment for type III congenital radioulnar synostosis.