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桡骨远端畸形愈合矫正截骨术后的腕管综合征:1例罕见病例报告及文献复习

Carpal Tunnel Syndrome Following Corrective Osteotomy for Distal Radius Malunion: A Rare Case Report and Review of the Literature.

作者信息

Gary Cyril, Shah Ajul, Kanouzi Jack, Golas Alyssa R, Frey Jordan D, Le Brian, Hacquebord Jacques, Thanik Vishal

机构信息

1 Yale University, School of Medicine, Division of Plastic Surgery, New Haven, CT, USA.

2 New York University, School of Medicine, Deparment of Plastic Surgery, New York City, USA.

出版信息

Hand (N Y). 2017 Sep;12(5):NP157-NP161. doi: 10.1177/1558944717708053. Epub 2017 May 16.

DOI:10.1177/1558944717708053
PMID:28511570
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5684953/
Abstract

BACKGROUND

Although median nerve neuropathy and carpal tunnel syndrome (CTS) are known complications of both untreated and acutely treated distal radius fracture, median neuropathy after correction of distal radius malunion is not commonly reported in hand surgery literature. We describe a patient with severe CTS after corrective osteotomy, open reduction internal fixation (ORIF) with a volar locking plate (VLP), and bone grafting for distal radius malunion.

METHODS

We report a case of severe acute CTS as a complication of corrective osteotomy with bone grafting for distal radius malunion.

RESULTS

The patient was treated with surgical exploration of the median nerve and carpal tunnel release.

CONCLUSION

The authors report a case of acute CTS after ORIF with VLP for a distal radius malunion warranting surgical exploration and carpal tunnel release. Treatment teams must be aware of this potential complication so that the threshold for reoperation is low and irreversible damage to the median nerve is prevented.

摘要

背景

虽然正中神经病变和腕管综合征(CTS)是未经治疗和急性治疗的桡骨远端骨折已知的并发症,但在手部外科文献中,桡骨远端畸形愈合矫正后正中神经病变并不常见。我们描述了1例在进行截骨矫正、掌侧锁定钢板(VLP)切开复位内固定(ORIF)及植骨治疗桡骨远端畸形愈合后出现严重CTS的患者。

方法

我们报告1例严重急性CTS病例,该病例为桡骨远端畸形愈合截骨矫正联合植骨的并发症。

结果

患者接受了正中神经手术探查及腕管松解术治疗。

结论

作者报告1例采用VLP进行ORIF治疗桡骨远端畸形愈合后出现急性CTS的病例,该病例需要进行手术探查及腕管松解。治疗团队必须意识到这种潜在并发症,以便降低再次手术阈值并防止正中神经发生不可逆损伤。

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本文引用的文献

1
Treatment of neglected malunion of the distal radius: a cases series study.桡骨远端陈旧性畸形愈合的治疗:一项病例系列研究。
Med J Islam Repub Iran. 2014 Feb 17;28:7. eCollection 2014.
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Correction osteotomy of distal radius malunion stabilised with dorsal locking plates without grafting.采用背侧锁定钢板固定且不植骨的桡骨远端畸形愈合矫正截骨术
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Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures: a randomized, controlled study.不稳定型桡骨远端骨折中掌侧锁定钢板与外固定及辅助钢针固定的比较:一项随机对照研究
J Hand Surg Am. 2013 Aug;38(8):1469-76. doi: 10.1016/j.jhsa.2013.04.039.
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Median neuropathy in malunited fractures of the distal radius.桡骨远端畸形愈合的正中神经病变。
Arch Orthop Trauma Surg. 2013 Sep;133(9):1321-7. doi: 10.1007/s00402-013-1803-9. Epub 2013 Jul 18.
5
Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius.多平面 K 型钉非桥接外固定与掌侧锁定钢板治疗桡骨远端背侧移位骨折。
Arch Orthop Trauma Surg. 2013 May;133(5):595-602. doi: 10.1007/s00402-013-1698-5. Epub 2013 Feb 19.
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Carpal tunnel syndrome after distal radius fracture.桡骨远端骨折后腕管综合征
Orthop Clin North Am. 2012 Oct;43(4):521-7. doi: 10.1016/j.ocl.2012.07.021. Epub 2012 Sep 4.
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Corrective osteotomy for combined intra- and extra-articular distal radius malunion.桡骨远端关节内和关节外联合畸形愈合的矫正截骨术
J Hand Surg Am. 2012 Oct;37(10):2041-9. doi: 10.1016/j.jhsa.2012.07.013. Epub 2012 Aug 31.
8
Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting.使用掌侧锁定钢板且不植骨矫正背侧愈合不良的桡骨远端关节外骨折。
J Bone Joint Surg Br. 2012 Aug;94(8):1090-6. doi: 10.1302/0301-620X.94B8.28646.
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Dorsally displaced extra-articular distal radius fractures fixation: Dorsal IM nailing versus volar plating. A randomized controlled trial.背侧移位关节外桡骨远端骨折固定:背侧 IM 钉与掌侧钢板固定。一项随机对照试验。
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10
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