Simcock Xavier, Shah Apurva S, Waters Peter M, Bae Donald S
*Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA †Division of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2015 Dec;35(8):838-43. doi: 10.1097/BPO.0000000000000370.
Congenital radioulnar synostosis (CRUS) refers to an abnormal connection between the radius and ulna due to embryological failure of separation. Derotational osteotomy has been advocated for children with functional limitations, although historically this procedure has been associated with a 36% complication rate including compartment syndrome and loss of correction.
A retrospective evaluation of consecutive patients who underwent derotational osteotomy for CRUS at a single institution was performed. Children with functional limitations secondary to excessive pronation were indicated for surgery with a goal of correction to 10 to 20 degrees of pronation. All patients were treated with a standardized surgical technique including careful subperiosteal elevation, rotational osteotomy at the level of the synostosis, control of the osteotomy fragments, appropriate pinning techniques, and prophylactic forearm fasciotomies. Electronic medical records, preoperative radiographs, and postoperative radiographs were reviewed.
Derotational osteotomy was performed in 31 forearms in 26 children (13 bilateral, 13 unilateral) with a mean age of 6.8 years (range, 3.0 to 18.8 y). The mean clinical follow-up was 46 months (range, 6 to 148 mo). The mean preoperative pronation deformity was 85 degrees (range, 60 to 100 degrees). The mean correction achieved was 77 degrees (range, 40 to 95 degrees), resulting in a mean final position of 8 degrees of pronation (range, 0 to 30 degrees). All patients successfully achieved union by 8 weeks postoperatively. There were no cases of compartment syndrome, vascular compromise, or loss of fixation. The overall complication rate was 12% (2 transient anterior interosseous nerve palsies, 1 transient radial nerve palsy, 1 symptomatic muscle herniation). Both transient anterior interosseous nerve palsies occurred in patients with rotational corrections exceeding 80 degrees.
Derotational osteotomy can be safely and effectively performed in children with CRUS. Meticulous surgical technique, including control of the osteotomy, judicious pin fixation, and prophylactic fasiotomies, may diminish the risk of neurovascular compromise and loss of correction. Transient anterior interosseous nerve palsies occurred, and may be related to large rotational corrections.
先天性桡尺骨融合（CRUS）是指由于胚胎期分离失败导致桡骨和尺骨之间出现异常连接。对于有功能受限的儿童，一直提倡采用旋转截骨术，尽管从历史上看，该手术的并发症发生率为36%，包括骨筋膜室综合征和矫正丢失。
对在单一机构接受CRUS旋转截骨术的连续患者进行回顾性评估。因旋前过度导致功能受限的儿童被列为手术对象，目标是将旋前矫正至10至20度。所有患者均采用标准化手术技术治疗，包括仔细的骨膜下剥离、在融合水平进行旋转截骨、控制截骨碎片、适当的穿针技术以及预防性前臂筋膜切开术。查阅了电子病历、术前X线片和术后X线片。
26例儿童（13例双侧，13例单侧）的31条前臂接受了旋转截骨术，平均年龄为6.8岁（范围3.0至18.8岁）。平均临床随访时间为46个月（范围6至148个月）。术前平均旋前畸形为85度（范围60至100度）。平均矫正度数为77度（范围40至95度），最终平均旋前位置为8度（范围0至30度）。所有患者术后8周均成功实现骨愈合。没有发生骨筋膜室综合征、血管损伤或内固定失败的病例。总体并发症发生率为12%（2例短暂性骨间前神经麻痹、1例短暂性桡神经麻痹、1例有症状的肌肉疝）。2例短暂性骨间前神经麻痹均发生在旋转矫正超过80度的患者中。
CRUS患儿可以安全有效地进行旋转截骨术。细致的手术技术，包括控制截骨、明智地使用穿针固定和预防性筋膜切开术，可能会降低神经血管损伤和矫正丢失的风险。出现了短暂性骨间前神经麻痹，可能与较大的旋转矫正有关。
