Vuillermin Carley, Butler Lesley, Ezaki Marybeth, Oishi Scott
Boston Children's Hospital, Orthopedic Center, Boston, MA.
Texas Scottish Rite Hospital for Children, Charles E. Seay Jr Hand Center, Dallas, TX.
J Pediatr Orthop. 2018 Apr;38(4):244-248. doi: 10.1097/BPO.0000000000000807.
Centralization is commonly utilized for treating the severely deviated wrist in radial longitudinal deficiency (RLD). Individuals with RLD have congenital shortening of the ulna and previous studies have shown that traditional centralization, in particular with notching of the carpus, results in additional ulnar growth retardation. At our institution, we use a technique of soft tissue release with bilobed flap. We examined if this technique preserves the growth potential of the distal ulna, therefore, avoiding an additionally shortened forearm.
We retrospectively reviewed serial radiographs of 16 patients with 18 wrists who had at least 3 years of follow-up after a soft tissue release with bilobed flap. Radiographic lengths were measured using the method described by Heikel. Percentage of normal growth was calculated using normative data published by Maresh. Comparisons were made with preoperative, postoperative, and final follow-up studies.
The average length of follow-up was 9.2 years (range, 3 to 16.3 y) with an average age of 11.6 years (range, 5.2 to 17.5 y). The average age at the time of surgery was 27 months (range, 14 to 48 mo). A minimum of 3 radiographic studies were available for each subject. The average ulna length preoperatively was 63.9% of age-matched normal length (51.4% to 75.3%). The average ulna length at final follow-up was 61.9% of age-matched normal length (48.5% to 70.3%). The difference was not statistically significant. In addition, there were no distal ulnar physeal arrests.
Soft tissue release with bilobed flap does not affect ulna growth like traditional centralization procedures can. This procedure has previously been shown to retain motion and have similar recurrence rates to formal centralizations. Therefore, we advocate that it be considered more widely for use in patients with RLD and significant wrist deviation to maximize growth and improve hand position. Soft tissue release with bilobed flap can be safely used on young children and preserve ulnar growth.
Level IV-therapeutic.
中心化术常用于治疗桡骨纵列发育不全（RLD）中严重偏斜的腕关节。RLD患者存在尺骨先天性短缩，既往研究表明，传统的中心化术，尤其是伴有腕骨开槽的术式，会导致尺骨进一步生长迟缓。在我们机构，我们采用双叶皮瓣软组织松解技术。因此，我们研究了该技术是否能保留尺骨远端的生长潜力，从而避免前臂进一步缩短。
我们回顾性分析了16例患者18个腕关节的系列X线片，这些患者在接受双叶皮瓣软组织松解术后至少随访了3年。采用Heikel描述的方法测量X线片上的长度。使用Maresh公布的标准数据计算正常生长百分比。对术前、术后及最终随访研究进行比较。
平均随访时间为9.2年（范围3至16.3年），平均年龄为11.6岁（范围5.2至17.5岁）。手术时的平均年龄为27个月（范围14至48个月）。每个受试者至少有3次X线检查资料。术前尺骨平均长度为同年龄正常长度的63.9%（51.4%至75.3%）。最终随访时尺骨平均长度为同年龄正常长度的61.9%（48.5%至70.3%）。差异无统计学意义。此外，没有尺骨远端骨骺阻滞。
双叶皮瓣软组织松解术不像传统的中心化术那样影响尺骨生长。此前已证明该术式能保留活动度，且复发率与正规中心化术相似。因此，我们主张更广泛地考虑将其用于RLD且腕关节明显偏斜的患者，以最大限度地促进生长并改善手部位置。双叶皮瓣软组织松解术可安全用于幼儿并保留尺骨生长。
四级治疗性。
