桥接组合系统在尺骨短缩截骨术治疗尺骨撞击综合征中的应用

Application of Ortho-Bridge Combination System in the treatment of ulnar impaction syndrome with ulna-shortening osteotomy

目的探讨桥接组合系统实现精确截骨缩短治疗尺骨撞击综合征的临床效果。方法回顾性分析2020年1月到2022年3月收治的25例尺骨撞击综合征患者资料,均采用桥接组合系统行尺骨短缩术(USO)。女14例,男11例;年龄(43.2±10.1)岁。术前根据患者CT结果规划手术,制定个性化截骨方案。术中先将桥接组合系统固定于尺骨,按照术前规划截骨,通过桥接组合系统加压闭合截骨间隙后锁定螺钉固定。记录截骨愈合时间、并发症、关节活动度及握力指标,通过疼痛视觉模拟评分(VAS)和腕关节功能Mayo评分评价治疗效果。结果所有患者术后随访时间为(13.5±1.2)个月;所有患者尺骨变异获得矫正,截骨端愈合,无成角、旋转等并发症。末次随访时患者的腕关节疼痛VAS评分[2.0(1.0,2.0)分]较术前[6.0(5.0,6.5)分]显著下降,腕关节Mayo评分[(85.4±8.9)分]、握力[(39.4±1.2)kg]、腕关节屈-伸(111.9°±12.6°)、旋前-旋后(133.2°±15.7°),尺-桡偏(35.3°±2.8°)活动度均较术前[(69.2±13.3)分、(31.3±5.2)kg、102.0°±16.0°、128.0°±15.5°、32.2°±2.8°]显著改善,差异均有统计学意义(P<0.05)。结论桥接组合系统可以优化尺骨撞击综合征患者行USO的过程,纠正尺骨变异,避免旋转、成角等并发症,改善腕关节功能。

Objective To investigate the clinical outcomes of Ortho-Bridge Combination System(OBCS)to achieve precise ulna-shortening osteotomy(USO)in the treatment of ulnar impaction syndrome.Methods A retrospective study was conducted to analyze the 25 patients with ulnar impaction syndrome who had been treated at Institute of Orthopedic Trauma Research,The 920th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army between January 2020 to March 2022.The patients all underwent USO using OBCS.They were 14 females and 11 males with an age of(43.2±10.1)years.Their CT scans were retrieved for preoperative planning and design of a personalized USO.Intraoperatively,OBCS was fixated to the ulna before USO.After the bone was resected according to preoperative planning,the gap between the osteotomy sites was closed with compression,and OBCS was finally fixated with locking screws.The time for bone union after resection,complications,range of motion and grip strength were recorded.The clinical outcomes were evaluated by visual analogue scale(VAS)and Mayo wrist score.Results All patients completed their operations successfully using OBCS.Their follow-up time was(13.5±1.2)months.The ulnar variation was corrected and osteotomy ends got united in all patients,without nonunion,angulation,or rotation.The wrist VAS significantly decreased from 6.0(5.0,6.5)points before operation to 2.0(1.0,2.0)points at the last follow-up(P<0.05).At the last follow-up,the Mayo wrist score[(85.4±8.9)points],grip strength[(39.4±1.2)kg],wrist flexion-extension(111.9°±12.6°),wrist pronation-supination(133.2°±15.7°),and ulnar radial deviation(35.3°±2.8°)were significantly increased compared with the preoperative values[(69.2±13.3)points,(31.3±5.2)kg,102.0°±16.0°,128.0°±15.5°,and 32.2°±2.8°](P<0.05).Conclusion In the treatment of ulnar impaction syndrome,OBCS can facilitate the process of USO,correct ulnar variance,and avoid complications like rotation and angulation to improve functions of the wrist.