El-Adl Wael
Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Acta Orthop Belg. 2007 Dec;73(6):704-9.
Congenital proximal radioulnar synostosis is a rare congenital anomaly that can be extremely disabling, especially when it occurs bilaterally or if there is severe hyperpronation. Currently, osteotomy to achieve a neutral or slightly pronated position is widely accepted for the management of patients who have severe pronation. The present study evaluates the result of two-stage double-level rotational osteotomy of both the radius and ulna in the treatment of severe congenital radioulnar synostosis. Nine children with severe congenital radioulnar synostosis underwent two-stage double-level rotational osteotomy of both the radius and ulna at Mansoura University Hospital. There were seven boys and two girls with a mean age of 5.6 years who were followed up for a mean of 26 months. The position of the forearm was improved from a mean pronation deformity of 76 degrees (60 degrees to 85 degrees) to 30 degrees of pronation in the affected dominant extremities and 20 degrees of supination in non-dominant extremities in all cases. Bony union was achieved by 5.9 weeks with no loss of correction. The advantages of this technique are that it is easy, safe, with absence of severe postoperative complications and requires a small surgical scar. A drawback of the technique is that the rotation correction depends only on a cast, so that a correction loss might occur if the plaster cast loosens.
先天性近端桡尺关节融合是一种罕见的先天性异常，可能会导致严重的功能障碍，尤其是在双侧发病或存在严重旋前畸形时。目前，对于有严重旋前畸形的患者，通过截骨术使前臂达到中立位或轻度旋前位已被广泛接受用于治疗。本研究评估了桡骨和尺骨两阶段双平面旋转截骨术治疗严重先天性桡尺关节融合的效果。9例患有严重先天性桡尺关节融合的儿童在曼苏拉大学医院接受了桡骨和尺骨两阶段双平面旋转截骨术。其中有7名男孩和2名女孩，平均年龄5.6岁，平均随访26个月。所有病例中，患侧优势肢体的前臂位置从平均76度（60度至85度）的旋前畸形改善为30度旋前，非优势肢体为20度旋后。术后5.9周实现了骨愈合，且无矫正丢失。该技术的优点是操作简便、安全，术后无严重并发症，手术瘢痕小。该技术的一个缺点是旋转矫正仅依赖于石膏固定，因此如果石膏松动可能会出现矫正丢失。
