Wada Takuro, Isogai Satoshi, Kanaya Kohei, Tsukahara Tomohide, Yamashita Toshihiko
Department of Orthopaedic Surgery, Sapporo Medical University, School of Medicine, South 1 West 16, Sapporo 060-8543, Japan.
J Hand Surg Am. 2004 Mar;29(2):264-72. doi: 10.1016/j.jhsa.2003.12.001.
Closing wedge osteotomies are an attractive treatment option for distal radius malunion in patients with osteopenia; however, they require an ulnar head resection to accommodate closure of corrective osteotomy and to address the issue of ulnocarpal abutment. The literature contains little information on concomitant ulnar shortening osteotomy despite a physiologic solution. We report the functional and radiographic outcomes of 5 patients treated for symptomatic distal radius malunion with simultaneous radial closing wedge and ulnar shortening osteotomies.
All 5 patients were women aged 52 to 69 years (average, 61 years). Four patients had extra-articular radius fractures with dorsal angulation (20-22 degrees ) and shortening (3-7/mm); the other had the fracture with volar angulation (24 degrees ) and shortening (11 mm). Through a volar approach an appropriate amount of bone wedge was removed from the distal radius. A small volar T-plate was used to secure the osteotomized bone fragment. Six to 11 mm of ulnar shortening osteotomy was performed by using transverse osteotomy and compression plating technique with an AO compression device.
In all 5 wrists healing of radial and ulnar osteotomies occurred less than 3 months after surgery. There were no postsurgical complications. Postsurgical radiographs showed that the volar tilt angle of the radius was reduced to normal range (range, 8-15 degrees ) in all wrists. The ulnar variance was 0 mm in 4 wrists and 2 mm in 1 wrist. There were significant improvements in pain, function, and range of motion at an average follow-up evaluation of 17 months. The average grip strength as a percentage of the opposite side improved from 30% before to 73% after surgery.
This study showed that closing wedge osteotomy of the radius concomitant with ulnar shortening osteotomy is technically and functionally adequate. Our procedure is indicated for patients with osteopenia for whom opening wedge osteotomy of the radius is inadequate.
闭合楔形截骨术是骨质疏松患者桡骨远端畸形愈合的一种有吸引力的治疗选择；然而，为适应矫正截骨术的闭合并解决尺腕撞击问题，需要切除尺骨头。尽管这是一种符合生理的解决方案，但关于同期尺骨短缩截骨术相关的文献资料很少。我们报告了5例因有症状桡骨远端畸形愈合接受桡骨闭合楔形截骨术与尺骨短缩截骨术同时治疗患者的功能和影像学结果。
所有5例患者均为女性，年龄52至69岁（平均61岁）。4例患者为关节外桡骨骨折，伴有背侧成角（20 - 22度）和短缩（3 - 7/mm）；另1例患者骨折伴有掌侧成角（24度）和短缩（11 mm）。通过掌侧入路，从桡骨远端切除适量骨楔。使用小型掌侧T形钢板固定截骨后的骨块。采用AO加压装置的横向截骨和加压钢板技术进行6至11 mm的尺骨短缩截骨术。
所有5例腕部桡骨和尺骨截骨术均在术后不到3个月愈合。无术后并发症。术后X线片显示，所有腕部桡骨掌倾角均降至正常范围（范围为8 - 15度）。4例腕部尺骨变异为0 mm，1例为2 mm。在平均17个月的随访评估中，疼痛、功能和活动范围均有显著改善。患侧握力相对于对侧的平均百分比从术前的30%提高到术后的73%。
本研究表明，桡骨闭合楔形截骨术与尺骨短缩截骨术在技术和功能上是可行的。我们的手术方法适用于桡骨开放楔形截骨术不适用的骨质疏松患者。
