桡骨远端穹窿截骨合并Vickers韧带松解治疗马德隆畸形的临床疗效

Clinical efficacy of distal radius dome osteotomy combined with Vickers ligament release in the treatment of Madelung′s deformity

目的:分析桡骨远端穹窿截骨合并Vickers韧带松解(DRO+VR)治疗马德隆畸形的临床疗效。方法:回顾性病例系列分析。收集2012年1月至2023年8月南京医科大学附属儿童医院治疗的15例马德隆畸形患儿的临床资料,根据术式将患儿分为DRO+VR组和其他术式组。记录随访时间,测量术前及末次随访时的尺侧倾斜角(UT)、月骨下沉(LS)、掌腕移位(PCD)、月骨窝角(LFA)、腕关节掌屈(WF)、腕关节背伸(WE)及疼痛视觉模拟评分(VAS)。计量资料比较采用独立样本t检验,分类变量比较采用Fisher′s确切概率法。结果:随访10~96个月,DRO+VR组随访时间(27.17±15.51)个月,其他术式组随访时间(48.00±24.06)个月。2组患儿术前一般资料、影像学指标及功能评估情况比较,差异均无统计学意义(均P>0.05)。DRO+VR组患儿术前与终末随访时影像学指标及功能评估情况比较,术前UT[(49.00±3.10)°]、LFA[(34.50±3.78)°]、LS[(7.29±3.61)mm]、PCD[(12.06±3.39)mm]、WF[(61.17±1.47)°]、WE[(48.67±1.86)°]、VAS[(7.33±1.03)分]与终末随访UT[(31.83±2.40)°]、LFA[(49.83±4.02)°]、LS[(2.29±1.48)mm]、PCD[(4.35±2.37)mm]、WF[(67.50±3.33)°]、WE[(60.50±4.42)°]、VAS[(2.67±0.52)分]比较,差异均有统计学意义(均P<0.05)。2组患儿终末随访时影像学指标及功能评估与术前改善比较结果显示,DRO+VR组UT的改善为(17.17±2.32)°,其他术式组为(51.78±7.66)°,差异有统计学意义(t=-2.241,P=0.043)。结论:DRO+VR是治疗儿童马德隆畸形的有效手段,可显著改善患儿影像学指标及腕关节功能,显著缓解疼痛症状。对于有疼痛症状、畸形严重的马德隆畸形,应积极选择手术治疗。

ObjectiveTo analyze the clinical efficacy of the distal radius dome osteotomy combined with Vickers ligament release(DRO+VR)in the treatment of Madelung′s deformity.MethodsA retrospective case series analysis.The clinical data of 15 children with Madelung′s deformity treated in the Children′s Hospital of Nanjing Medical University from January 2012 to August 2023 were collected,and the children were divided into the DRO+VR group and the other operation group according to the surgical method.The follow-up time was recorded,and the ulnar tilt(UT),lunate subsidence(LS),palmar carpal displacement(PCD),lunate fossa angle(LFA),wrist flexion(WF),wrist extension(WE),and visual analogue scale(VAS)were measured before surgery and at the last follow-up.The independent samples t-test was used for measurement data comparison,and the Fisher′s exact test was used for categorical variable comparison.ResultsThe follow-up time was 10-96 months,with the time of(27.17±15.51)months in the DRO+VR group and(48.00±24.06)months in the other operation group.There was no significant difference in preoperative general data,imaging indexes and functional evaluation between the 2 groups(all P>0.05).The comparison of imaging indexes and functional evaluation of children in the DRO+VR group before surgery and at the last follow-up showed that the differences in UT[(49.00±3.10)°vs.(31.83±2.40)°],LFA[(34.50±3.78)°vs.(49.83±4.02)°],LS[(7.29±3.61)mm vs.(2.29±1.48)mm],PCD[(12.06±3.39)mm vs.(4.35±2.37)mm],WF[(61.17±1.47)°vs.(67.50±3.33)°],WE[(48.67±1.86)°vs.(60.50±4.42)°],and VAS[(7.33±1.03)points vs.(2.67±0.52)points]were statistically significant(all P<0.05).At the last follow-up,the results of imaging indexes and functional evaluation of the 2 groups showed that the improvement of UT was(17.17±2.32)°in the DRO+VR group and(51.78±7.66)°in the other operation group,which had statistically difference(t=-2.241,P=0.043).ConclusionsDRO+VR is an effective approach for treating Madelung′s deformity in children.It can significantly improve children′s imaging indexes and wrist joint function and alleviate pain symptoms.Surgical intervention should be actively considered for patients with severe deformity and pain symptoms related to Madelung′s deformity.