Gaspar Michael P, Kane Patrick M, Pflug Emily M, Jacoby Sidney M, Osterman A Lee, Culp Randall W
The Philadelphia Hand Center, P.C., Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
The Philadelphia Hand Center, P.C., Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2016 Sep;25(9):1491-500. doi: 10.1016/j.jse.2016.04.018. Epub 2016 Jun 30.
The purpose of this study was to report outcomes of interosseous membrane (IOM) reconstruction with a suture-button construct for treatment of chronic longitudinal forearm instability.
We performed a retrospective review with prospective follow-up of patients who underwent ulnar shortening osteotomy and IOM reconstruction with the Mini TightRope device from 2011 through 2014. Bivariate statistical analysis was used for comparison of preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, range of motion, grip strength, and ulnar variance. Complications and patient satisfaction were also recorded.
Ten patients (mean age, 45.3 years) satisfied inclusion criteria: 8 treated for post-traumatic sequelae of Essex-Lopresti-type injuries, 1 for forearm instability secondary to previous elbow surgery, and 1 for instability secondary to trauma and multiple elbow surgeries. Surgeries were performed an average of 28.6 months from initial injury. At mean follow-up of 34.6 months after surgery, significant improvement was observed in elbow flexion-extension arc (+23° vs. preoperatively; P = .007), wrist flexion-extension arc (+22°; P = .016), QuickDASH score (-48; P = .000), and ulnar variance (-3.3 mm; P = .006). Three patients required additional surgery: 1 revision ulnar shortening osteotomy for persistent impingement, 1 revision ulnar osteotomy and Mini TightRope removal for lost forearm supination, and 1 fixation of a radial shaft fracture after a fall.
IOM reconstruction using a suture-button construct is an effective treatment option for chronic forearm instability.
本研究旨在报告采用缝线纽扣装置重建骨间膜（IOM）治疗慢性前臂纵向不稳定的疗效。
我们对2011年至2014年接受尺骨短缩截骨术并用Mini TightRope装置重建IOM的患者进行了回顾性研究，并进行前瞻性随访。采用双变量统计分析比较术前和术后上肢、肩部和手部快速残疾评定量表（QuickDASH）评分、活动范围、握力和尺骨差异。还记录了并发症和患者满意度。
10例患者（平均年龄45.3岁）符合纳入标准：8例因埃塞克斯-洛普雷斯蒂型损伤的创伤后遗症接受治疗，1例因先前肘部手术继发前臂不稳定接受治疗，1例因创伤和多次肘部手术继发不稳定接受治疗。手术平均在初次受伤后28.6个月进行。术后平均随访34.6个月时，观察到肘屈伸弧显著改善（+23° vs术前；P = 0.007），腕屈伸弧（+22°；P = 0.016），QuickDASH评分（-48；P = 0.000）和尺骨差异（-3.3 mm；P = 0.006）。3例患者需要再次手术：1例因持续撞击行尺骨短缩截骨术翻修，1例因前臂旋后丧失行尺骨截骨术翻修并取出Mini TightRope，1例因跌倒后桡骨干骨折行内固定。
采用缝线纽扣装置重建IOM是治疗慢性前臂不稳定的有效方法。
