VanHeest Ann
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
Tech Hand Up Extrem Surg. 2010 Jun;14(2):94-9. doi: 10.1097/BTH.0b013e3181da05aa.
Although the role of wrist centralization has been controversial, the surgeon must knowledgeably make surgical decisions for patients with radial longitudinal deficiency, understanding the advantages and disadvantages of centralization techniques. The goals of surgical intervention for correction of radial longitudinal deficiency are to correct the radial deviation deformity of the wrist by centralizing the carpus on the distal end of the ulna, concomitant with balancing the soft tissue structures at the wrist maintaining finger and wrist motion. Wrist centralization is indicated in children with complete absence of the radius with elbow range of motion of greater than 90 degrees, and stable medical condition. This article presents the technique of wrist centralization surgery using a dorsal rotation flap. The wrist capsule is released from the radial side of the ulna, and the carpus is relocated over the distal end of the ulna, with a longitudinal pin placed through the ulna, across the carpus, and between or down the middle ray metacarpal. If the ulna has greater than 30 degrees angulation, a concomitant ulnar osteotomy is performed. Complications can include recurrence, pin problems, stiff digits, and diminished long-term ulnar growth. Long-term splint wear may be necessary to decrease the risk of recurrence. At the present time, an optimal single surgical technique for intervention for this complex congenital deformity has not yet been described.
尽管腕关节中心化的作用一直存在争议，但外科医生必须在了解中心化技术优缺点的基础上，为桡骨纵向发育不全的患者明智地做出手术决策。矫正桡骨纵向发育不全的手术干预目标是通过将腕骨集中于尺骨远端来纠正腕关节的桡偏畸形，同时平衡腕部的软组织结构，保持手指和腕关节的活动。腕关节中心化适用于桡骨完全缺如、肘关节活动范围大于90度且身体状况稳定的儿童。本文介绍了使用背侧旋转皮瓣进行腕关节中心化手术的技术。从尺骨桡侧松解腕关节囊，将腕骨重新定位到尺骨远端上方，通过尺骨、穿过腕骨并在中间掌骨之间或沿其放置一根纵向钢针。如果尺骨有大于30度的成角，则同时进行尺骨截骨术。并发症可能包括复发、钢针问题、手指僵硬和尺骨长期生长受限。可能需要长期佩戴夹板以降低复发风险。目前，尚未描述针对这种复杂先天性畸形的最佳单一手术干预技术。
