VanHeest Ann E, Lin Toni E, Bohn Deborah
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
J Pediatr Orthop. 2013 Jul-Aug;33(5):540-3. doi: 10.1097/BPO.0b013e318292c187.
Congenital radioulnar synostosis (CRUS) causes a spectrum of presentations, most commonly a restriction of forearm rotation. Because most of these children are not treated operatively, many are not followed clinically after the diagnosis has been made. This report describes that a subset of the Cleary and Omer type IV synostoses (anterior dislocation of the radial head) can present with a progressive block to elbow flexion that worsens with growth. The location of this synostosis allows the physis of the radial head to grow untethered. The enlarged radial head can impinge upon the capitellum, blocking elbow flexion and snapping on the annular ligament. We propose excision of the radial head as a method of treating the anteriorly dislocated radial head in type IV synostoses.
We evaluated 4 patients with Cleary and Omer type IV synostoses who presented with an anteriorly dislocated radial head impinging on elbow flexion with snapping of the annular ligament. Each patient was treated with excision of the radial head.
In 4 patients excision of the radial head was performed through a lateral Kocher approach. At follow-up, all patients showed relief from their pain and mechanical symptoms, with return of baseline range of motion. One complication which occurred was transient radial nerve neuropraxia.
Although surgery is rarely needed for CRUS, excision of the radial head may be indicated if progressive loss of elbow flexion occurs secondary to impingement of the anteriorly dislocated radial head with the distal humerus in patients with type IV synostosis. We report that excision of the radial head can successfully treat this condition. Patients with type IV CRUS should be educated about the potential for loss of elbow flexion and/or followed until skeletal maturity to evaluate for this potential condition.
Case series consistent with level IV evidence; therapeutic study.
先天性桡尺骨融合（CRUS）会导致一系列表现，最常见的是前臂旋转受限。由于这些患儿大多未接受手术治疗，许多患儿在确诊后未接受临床随访。本报告描述了Cleary和Omer IV型融合（桡骨头前脱位）的一部分病例可出现肘关节屈曲渐进性受阻，且随生长而加重。这种融合的位置使桡骨头的骨骺能够不受束缚地生长。增大的桡骨头可撞击肱骨小头，阻碍肘关节屈曲并在环状韧带上产生弹响。我们建议切除桡骨头作为治疗IV型融合中前脱位桡骨头的一种方法。
我们评估了4例Cleary和Omer IV型融合且伴有前脱位桡骨头撞击肘关节屈曲并伴有环状韧带弹响的患者。每位患者均接受了桡骨头切除术。
4例患者均通过外侧Kocher入路进行了桡骨头切除术。随访时，所有患者的疼痛和机械性症状均缓解，恢复至基线活动范围。发生的1例并发症为短暂性桡神经失用。
尽管CRUS很少需要手术治疗，但对于IV型融合患者，如果因前脱位桡骨头撞击肱骨远端导致肘关节屈曲逐渐丧失，则可能需要切除桡骨头。我们报告切除桡骨头可成功治疗这种情况。应告知IV型CRUS患者存在肘关节屈曲丧失的可能性，和/或进行随访直至骨骼成熟，以评估这种潜在情况。
与IV级证据一致的病例系列；治疗性研究。
