Regan Deirdre K, Crespo Alexander M, Konda Sanjit R, Egol Kenneth A
Department of Orthopedics, NYU Hospital for Joint Diseases, New York, NY; Department of Orthopedics, Jamaica Hospital Medical Center, Jamaica, NY.
Department of Orthopedics, NYU Hospital for Joint Diseases, New York, NY; Department of Orthopedics, Jamaica Hospital Medical Center, Jamaica, NY.
J Hand Surg Am. 2018 Jun;43(6):564.e1-564.e9. doi: 10.1016/j.jhsa.2017.10.039. Epub 2017 Dec 8.
To describe one center's experience with nonunion of one or both bones of the forearm and report on the functional recovery of patients treated for a single- or 2-bone forearm nonunion.
We performed a retrospective analysis of 23 patients who presented to our institution over an 11-year period and underwent surgical repair of a forearm nonunion (radius, ulna, or both bones). The main outcome measurements included time to union, visual analog scale pain scores, range of motion, Short Musculoskeletal Function Assessment scores, and postoperative complications.
Of the 23 patients, 21 (91.3%) healed their nonunion after a single surgical procedure. All patients ultimately healed their nonunion; 7 patients were healed at 3-month follow-up, 11 healed at 6-month follow-up, and 5 healed at 12-month follow-up. Mean visual analog scale pain scores improved considerably from presentation to latest follow-up. The mean range of motion at the latest follow-up was as follows: elbow 130.9° flexion-extension arc, forearm 78.5° pronation/77.8° supination, and wrist 76.1° palmar flexion/74.3° dorsiflexion. Mean Short Musculoskeletal Function Assessment arm and hand index scores improved significantly from baseline to the latest follow-up. Mean Short Musculoskeletal Function Assessment function, activity, and bothersome indices demonstrated improvement, though this was not statistically significant. Two patients required further surgery to achieve osseous union. One patient sustained an iatrogenic posterior interosseous nerve palsy, which resolved spontaneously.
Repair of forearm nonunion with compression plating and bone grafting provides reliable clinical and functional outcomes. Patients treated surgically for nonunion of one or both of the forearm bones can expect to heal with the potential for considerable improvements in pain and function postoperatively.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
描述某中心处理前臂单骨或双骨骨不连的经验，并报告接受单骨或双骨前臂骨不连治疗患者的功能恢复情况。
我们对11年间到本机构就诊并接受前臂骨不连（桡骨、尺骨或双骨）手术修复的23例患者进行了回顾性分析。主要观察指标包括骨愈合时间、视觉模拟评分法疼痛评分、活动范围、简短肌肉骨骼功能评估评分及术后并发症。
23例患者中，21例（91.3%）经单次手术实现骨不连愈合。所有患者最终均实现骨不连愈合；7例在3个月随访时愈合，11例在6个月随访时愈合，5例在12个月随访时愈合。从就诊到最新随访，视觉模拟评分法疼痛评分均值显著改善。最新随访时的平均活动范围如下：肘关节屈伸弧为130.9°，前臂旋前78.5°/旋后77.8°，腕关节掌屈76.1°/背伸74.3°。简短肌肉骨骼功能评估的手臂和手部指数评分从基线到最新随访有显著改善。简短肌肉骨骼功能评估的功能、活动及困扰指数虽有改善，但差异无统计学意义。2例患者需要进一步手术以实现骨愈合。1例患者发生医源性骨间后神经麻痹，后自行缓解。
采用加压钢板和植骨修复前臂骨不连可提供可靠的临床和功能结果。接受单骨或双骨前臂骨不连手术治疗的患者有望实现愈合，术后疼痛和功能有显著改善的可能。
研究类型/证据水平：治疗性IV级。
