Matsubara Hidenori, Tsuchiya Hiroyuki, Sakurakichi Keisuke, Yamashiro Teruhisa, Watanabe Koji, Tomita Katsuro
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
J Orthop Sci. 2006 Oct;11(5):459-66. doi: 10.1007/s00776-006-1047-4.
Multiple cartilaginous exostoses cause various deformities of the epiphysis. In exostoses of the ulna, the ulna is shortened and the radius acquires varus deformity, which may lead to dislocation of the radial head. In this study, we present the results of exostoses resection, with correction and lengthening with external fixators for functional and cosmetic improvement, and prevention of radial head dislocation.
We retrospectively reviewed seven forearms of seven patients who had deformities of the forearm associated with multiple cartilaginous exostoses. One patient had dislocation of the radial head. Operative technique was excision of osteochondromas from the distal ulna, correction of the radius, and ulnar lengthening with external fixation up to 5 mm plus variance. We evaluated radiographs and the range of pronation and supination. Furthermore, we conducted a follow-up of ulnar length after the operation.
Dislocation of the radial head of one patient was naturally reduced without any operative intervention. At the most recent follow-up, six of the seven patients showed full improvement in pronation-supination. Ulnar shortening recurred with skeletal growth of four skeletally immature patients; however, it did not recur in one skeletally mature patient. Overlength of 5 mm was negated by the recurrence of ulnar shortening about 1.5 years after the operation.
We treated seven forearms of seven patients by excision of osteochondromas, correction of radii, and gradual lengthening of ulnas with external fixators. The results of the procedure were satisfactory, especially for function of the elbow and wrist. However, we must consider the possible recurrence of ulnar shortening within about 1.5 years during skeletal growth periods in immature patients.
多发性软骨外生骨疣可导致骨骺出现各种畸形。在尺骨外生骨疣中，尺骨缩短，桡骨出现内翻畸形，这可能导致桡骨头脱位。在本研究中，我们展示了通过切除外生骨疣、使用外固定器进行矫正和延长以改善功能和外观，并预防桡骨头脱位的结果。
我们回顾性分析了7例患有与多发性软骨外生骨疣相关的前臂畸形患者的7条前臂。1例患者出现桡骨头脱位。手术技术为切除尺骨远端的骨软骨瘤，矫正桡骨，并使用外固定器将尺骨延长5毫米并矫正成角畸形。我们评估了X线片以及旋前和旋后范围。此外，我们对术后尺骨长度进行了随访。
1例患者的桡骨头脱位未经任何手术干预自然复位。在最近的随访中，7例患者中有6例旋前 - 旋后功能完全改善。4例骨骼未成熟患者随着骨骼生长尺骨缩短复发；然而，1例骨骼成熟患者未复发。术后约1.5年，尺骨缩短复发抵消了5毫米的过度延长。
我们通过切除骨软骨瘤、矫正桡骨以及使用外固定器逐渐延长尺骨治疗了7例患者的7条前臂。该手术结果令人满意，尤其是对肘部和腕部功能。然而，我们必须考虑在未成熟患者骨骼生长期间约1.5年内尺骨缩短可能复发的情况。
