Verhaegen Filip, Degreef Ilse, De Smet Luc
Department of Orthopaedic Surgery, U.Z. Pellenberg, Lubbeek, Pellenberg, Belgium.
J Hand Surg Am. 2010 Jan;35(1):57-61. doi: 10.1016/j.jhsa.2009.09.017.
To quantify 2 patterns of carpal malalignment, midcarpal malalignment (type 1) and radiocarpal malalignment (type 2), and to evaluate the effect of distal radius osteotomy on these malalignment patterns.
In a retrospective review, we studied 31 wrists treated with corrective osteotomy for distal radius malunion after Colles' fracture, in 31 patients (mean age, 44 y). The patients were divided on the basis of effective radiolunate flexion (ERLF) into 2 patterns of carpal malalignment as measured on preoperative radiographs. There were 20 patients with midcarpal malalignment (ERLF < or = 25 degrees ) and 11 with radiocarpal malalignment (ERLF > 25 degrees ). Measurements of alignment were repeated after distal radius osteotomy and compared with preoperative values.
Both groups had correction of radial tilt and ulnar variance with distal radius osteotomy. In the midcarpal malalignment group, carpal alignment improved to normal parameters. In the radiocarpal malalignment group, we observed a notable effect on the ERLF. Neither age of the subject nor delay between fracture and osteotomy correlated with improvement in carpal alignment.
Distal radial osteotomy is a reliable technique for correction of the deformity at the distal end of the radius and both radiocarpal and midcarpal malalignment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
量化腕关节排列不齐的两种模式，即腕中关节排列不齐（1型）和桡腕关节排列不齐（2型），并评估桡骨远端截骨术对这些排列不齐模式的影响。
在一项回顾性研究中，我们对31例（平均年龄44岁）因科雷氏骨折后桡骨远端畸形愈合接受矫正截骨术治疗的31个腕关节进行了研究。根据术前X线片测量的有效桡月关节屈曲（ERLF），将患者分为两种腕关节排列不齐模式。有20例腕中关节排列不齐患者（ERLF≤25度）和11例桡腕关节排列不齐患者（ERLF>25度）。桡骨远端截骨术后重复进行排列测量，并与术前值进行比较。
两组患者桡骨远端截骨术后桡骨倾斜和尺骨变异均得到矫正。在腕中关节排列不齐组，腕关节排列改善至正常参数。在桡腕关节排列不齐组，我们观察到对ERLF有显著影响。患者年龄和骨折与截骨术之间的间隔时间均与腕关节排列改善无关。
桡骨远端截骨术是矫正桡骨远端畸形以及桡腕关节和腕中关节排列不齐的可靠技术。
研究类型/证据水平：治疗性IV级。
