Cha Soo Min, Shin Hyun Dae, Ahn Ki Jun
1Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
J Bone Joint Surg Am. 2017 Apr 19;99(8):638-647. doi: 10.2106/JBJS.16.00366.
Ulnar shortening osteotomy (USO) is a widely adopted procedure with excellent outcomes. However, delayed union or nonunion has occasionally been observed. The purpose of this retrospective case-control study was to identify variables affecting osseous consolidation after USO in patients with ulnar impaction syndrome.
The study included 325 patients who had undergone USO between March 2008 and March 2014. We evaluated the association between union and basic demographic factors as well as preoperative pain (assessed on a visual analog scale [VAS]), range of wrist motion, grip strength, and modified Mayo wrist score. We also assessed the association of union with radiographic variables such as the degree of dorsal subluxation of the ulna, preoperative and postoperative ulnar variance, morphological type of the distal radioulnar joint, gap at the osteotomy site, and presence of newly developed arthritic changes during the follow-up period. Finally, variables associated with operative conditions, such as degeneration of the triangular fibrocartilage complex, use of a parallel double-blade saw, type of plate used for fixation, number of screws, and plate position on the volar or dorsal ulnar surface were investigated.
Ulnar union was achieved in 294 patients (group 1), and 31 patients had delayed union or nonunion (group 2). On univariate and multivariate analyses, smoking, low bone mineral density (BMD), a decreased range of motion of the wrist, and use of a double-blade saw were found to be significant factors for an adverse radiographic outcome (nonunion or delayed union).
Delayed union or nonunion occurred in about 10% of patients treated with USO. We suggest that it may be preferable to perform USO in nonsmokers, patients with normal bone density, and those without restricted wrist motion. Also, we recommend the use of a single-blade saw when performing the osteotomy.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
尺骨短缩截骨术（USO）是一种广泛应用且疗效良好的手术。然而，偶尔会观察到延迟愈合或不愈合的情况。本回顾性病例对照研究的目的是确定影响尺骨撞击综合征患者行USO后骨愈合的变量。
该研究纳入了2008年3月至2014年3月期间接受USO的325例患者。我们评估了愈合与基本人口统计学因素以及术前疼痛（采用视觉模拟量表[VAS]评估）、腕关节活动范围、握力和改良梅奥腕关节评分之间的关联。我们还评估了愈合与影像学变量的关联，如尺骨背侧半脱位程度、术前和术后尺骨长度差异、桡尺远侧关节形态类型、截骨部位间隙以及随访期间新出现的关节炎改变。最后，研究了与手术条件相关的变量，如三角纤维软骨复合体退变、使用平行双刃锯、固定所用钢板类型、螺钉数量以及钢板在尺骨掌侧或背侧表面的位置。
294例患者（第1组）实现了尺骨愈合，31例患者出现延迟愈合或不愈合（第2组）。单因素和多因素分析发现，吸烟、低骨密度（BMD）、腕关节活动范围减小以及使用双刃锯是不良影像学结果（不愈合或延迟愈合）的显著因素。
接受USO治疗的患者中约10%发生延迟愈合或不愈合。我们建议，对于不吸烟、骨密度正常且腕关节活动不受限的患者，进行USO可能更为合适。此外，我们建议在进行截骨术时使用单刃锯。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
