Sotereanos Dean G, Papatheodorou Loukia K, Williams Benjamin G
Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania.
Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania.
J Hand Surg Am. 2014 Mar;39(3):443-448.e1. doi: 10.1016/j.jhsa.2013.11.004. Epub 2013 Dec 18.
To evaluate the mid- to long-term outcome of distal radioulnar interposition arthroplasty using an Achilles allograft for salvage of painful instability after distal ulnar resection.
Twenty-six patients with an average age of 43 years were treated with Achilles tendon allograft interposition for failed distal ulnar resection. The average follow-up period was 79 months (range, 25-174 mo). Patients had an average of 2 previous procedures. All patients were evaluated clinically and radiographically. At the final follow-up, pain level, satisfaction, forearm rotation, grip strength, and Mayo Modified Wrist Score were assessed.
All clinical parameters demonstrated statistically significant improvement at the final follow-up. Mean patient pain scores improved from 8.1 to 1.3, and patient satisfaction scores improved by an average of 6.8 points. Preoperative and postoperative forearm rotation and grip strength measurements improved by an average of 28° in pronation, 41° in supination, and 72% in grip strength. The mean Mayo Modified Wrist Score improved from 42 to 85. Postoperative radiographs showed preservation of an adequate space between the distal radius and the resected distal ulna. No postoperative infections and no foreign body reactions relating to the allograft were observed.
Interposition arthroplasty with an Achilles allograft was an effective salvage procedure for the treatment of failed distal ulnar resection, preventing impingement of the ulnar stump on the radius. This procedure potentially provides a safe and reliable treatment, especially for patients who may not be candidates for implant arthroplasty.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
评估采用跟腱同种异体移植进行尺桡远侧关节间置成形术治疗尺骨远端切除术后疼痛性不稳定的中长期疗效。
26例平均年龄43岁的患者接受了跟腱同种异体移植间置术，用于治疗尺骨远端切除失败的情况。平均随访期为79个月（范围25 - 174个月）。患者平均之前接受过2次手术。所有患者均接受临床和影像学评估。在末次随访时，评估疼痛程度、满意度、前臂旋转度、握力和梅奥改良腕关节评分。
在末次随访时，所有临床参数均显示出统计学上的显著改善。患者平均疼痛评分从8.1降至1.3，患者满意度评分平均提高6.8分。术前和术后前臂旋转度和握力测量结果显示，旋前平均改善28°，旋后平均改善41°，握力平均提高72%。梅奥改良腕关节评分平均从42分提高到85分。术后X线片显示桡骨远端与切除的尺骨远端之间保留了足够的间隙。未观察到术后感染及与同种异体移植相关的异物反应。
跟腱同种异体移植间置成形术是治疗尺骨远端切除失败的有效挽救手术，可防止尺骨残端撞击桡骨。该手术可能提供一种安全可靠的治疗方法，尤其适用于可能不适合植入式关节成形术的患者。
研究类型/证据水平：治疗性IV级。
