Marquez-Lara Alejandro, Nuñez Fiesky A, Kiymaz Tunc, Nuñez Fiesky A, Li Zhongyu
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
J Hand Surg Am. 2017 Jun;42(6):477.e1-477.e8. doi: 10.1016/j.jhsa.2017.03.010. Epub 2017 Apr 20.
To compare the clinical and radiographic outcomes and complication rates of diaphyseal and metaphyseal ulnar shortening osteotomies for the treatment of ulnar abutment syndrome.
We performed a retrospective study comparing 35 patients who underwent either a metaphyseal (n = 14) or diaphyseal (n = 21) osteotomy. Radiographic and clinical outcomes were compared. Complication rates including infection, hardware removal, and reoperations were also assessed.
There were no differences in patient characteristics, ulnar variance, or pain and functional scores between groups. Metaphyseal osteotomy surgery time was shorter (45.5 vs 71.7 minutes) and resulted in greater ulnar shortening (4.8 vs 3.4 mm) compared with diaphyseal osteotomies. At an average 19.2-month follow-up, metaphyseal osteotomies were associated with greater improvement in pain and Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire scores. The need for implant removal was the same in both groups. There were no complications in either group.
Results from this study suggest that metaphyseal osteotomies are a safe and effective alternative to diaphyseal osteotomies for the management of ulnar abutment syndrome. Although improved surgical time and postoperative outcomes are encouraging, further large-scale and properly powered studies with long-term outcomes will help characterize the benefit of one technique over another. Ultimately, the decision between a metaphyseal and diaphyseal osteotomy may be surgeon preference.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
比较骨干和干骺端尺骨短缩截骨术治疗尺骨撞击综合征的临床和影像学结果以及并发症发生率。
我们进行了一项回顾性研究，比较了35例行干骺端截骨术（n = 14）或骨干截骨术（n = 21）的患者。比较了影像学和临床结果。还评估了包括感染、取出内固定物和再次手术在内的并发症发生率。
两组患者的特征、尺骨变异、疼痛和功能评分均无差异。与骨干截骨术相比，干骺端截骨术的手术时间更短（45.5分钟对71.7分钟），尺骨短缩更明显（4.8毫米对3.4毫米）。平均随访19.2个月时，干骺端截骨术在疼痛改善以及上肢、肩部和手部快速残疾问卷评分方面效果更佳。两组取出植入物的需求相同。两组均无并发症发生。
本研究结果表明，对于尺骨撞击综合征的治疗，干骺端截骨术是骨干截骨术的一种安全有效的替代方法。尽管手术时间的缩短和术后结果令人鼓舞，但进一步的大规模、有足够样本量且有长期结果的研究将有助于明确一种技术相对于另一种技术的优势。最终，选择干骺端截骨术还是骨干截骨术可能取决于外科医生的偏好。
研究类型/证据水平：治疗性IV级。
