Lozano-Calderón Santiago, Moore Michael, Liebman Matthew, Jupiter Jesse B
Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA.
J Hand Surg Am. 2007 Sep;32(7):976-83. doi: 10.1016/j.jhsa.2007.05.005.
To report our results after testing the combination of two technologies--angular-stable locking screw implants and Norian SRS cement--in corrective osteotomies of the distal radius in the elderly. This technique eliminates donor site bone-graft morbidity and expands the indications of corrective osteotomies to older patients with osteoporotic bone.
Our retrospective series include 6 patients (5 women and 1 man) with an average age of 60 years. Three patients had corrections through a dorsal approach, 1 through a volar approach, and 2 through a combined approach. Two corrections included an intraarticular osteotomy. We used 2.4-mm volar T plates in patients approached volarly and 2.4-mm L and T plates for those approached dorsally; the osseous defect was filled with bone cement (Norian SRS). Range of motion and grip strength were measured at 16 months average follow-up. Standard wrist radiographs were taken to evaluate alignment and determine improvement. At final follow-up, patients completed the Modified Mayo Wrist score, the Modified Gartland and Werley score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
There were no perioperative complications. All corrective osteotomies healed. One patient required a Darrach procedure at 6 months. The average wrist and forearm motion was 77% of the opposite side and grip strength 88% of the opposite side. The average total correction in the sagittal plane was 22 degrees with all patients returning to neutral or better alignment. The average ulnar variance improvement was 2 mm. Average postoperative DASH was 28 points; average Modified Mayo Wrist score was 68; and the Modified Gartland and Werley score averaged 9 points.
We believe that corrective osteotomy of the distal radius in the elderly using angular stable implants and Norian calcium phosphate cement is a safe and predictable surgical technique, even in patients with underlying osteoporosis. It eliminates donor site morbidity, and patient-rated outcome measures demonstrated acceptable daily living function return.
报告我们在老年患者桡骨远端截骨矫正术中联合应用两种技术——角度稳定锁定螺钉植入物和诺瑞安SRS骨水泥后的结果。该技术消除了供区骨移植的并发症，并将截骨矫正术的适应证扩展至患有骨质疏松性骨的老年患者。
我们的回顾性系列研究包括6例患者（5例女性和1例男性），平均年龄60岁。3例患者通过背侧入路进行矫正，1例通过掌侧入路，2例通过联合入路。2例矫正包括关节内截骨。对于采用掌侧入路的患者，我们使用2.4毫米掌侧T形钢板，对于采用背侧入路的患者，使用2.4毫米L形和T形钢板；骨缺损用骨水泥（诺瑞安SRS）填充。在平均随访16个月时测量活动范围和握力。拍摄标准腕部X线片以评估对线情况并确定改善情况。在最终随访时，患者完成改良梅奥腕关节评分、改良加特兰和韦利评分以及上肢、肩部和手部功能障碍（DASH）问卷。
无围手术期并发症。所有截骨矫正均愈合。1例患者在6个月时需要进行Darrach手术。患侧腕关节和前臂的平均活动度为对侧的77%，握力为对侧的88%。矢状面的平均总矫正角度为22度，所有患者均恢复至中立或更好的对线。尺骨变异平均改善2毫米。术后DASH平均评分为28分；改良梅奥腕关节平均评分为68分；改良加特兰和韦利评分平均为9分。
我们认为，即使对于患有潜在骨质疏松症的患者，在老年患者桡骨远端截骨矫正术中使用角度稳定植入物和诺瑞安磷酸钙骨水泥是一种安全且可预测的手术技术。它消除了供区并发症，患者自评的结果指标显示日常生活功能恢复情况可接受。
