Haider T, Geisler D, Thalhammer G, Erhart J
Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
BMC Musculoskelet Disord. 2017 Dec 13;18(1):529. doi: 10.1186/s12891-017-1895-4.
Malunion of phalangeal and metacarpal bones are often associated with impairment of hand function and pose a challenging task for treating surgeons in most cases. When applicable, corrective osteotomy is the treatment of choice, where the affected bone is cut to correct malalignment using chisels or saws. The use of these instruments is associated with several drawbacks especially in hand surgery. We aimed to determine whether a multiple drill-hole (MDH) osteotomy technique was suitable for performing corrective osteotomies of metacarpal and phalangeal bones.
This case series included 11 patients with malalignments or malunions of phalangeal or metacarpal bones. Corrective osteotomy was performed with the MDH technique. Follow-up examinations included clinical evaluations and radiography at frequent intervals, between 2 and 22 months postoperatively.
In all cases, planned osteotomies were technically feasible with the MDH technique. Apart from one case of a broken drillbit, no intraoperative or postoperative complication was recorded. All performed osteotomies healed within a mean of 6 weeks to radiological consolidation. In all cases, satisfactory results were achieved.
The present study was the first to test MDH osteotomy for hand surgery. We demonstrated that MDH was feasible for corrective osteotomies of metacarpal and phalangeal deformities. Advantages included excellent feasibility for osteotomies performed at varying angles, precise execution, reduced risk of collateral damage, and flexibility for performing intra-articular osteotomies.
指骨和掌骨畸形愈合常伴有手部功能障碍，在大多数情况下给外科治疗医生带来了具有挑战性的任务。在适用的情况下，截骨矫形术是首选治疗方法，即使用凿子或锯子切割受影响的骨骼以纠正畸形排列。这些器械的使用存在一些缺点，尤其是在手部手术中。我们旨在确定多钻孔（MDH）截骨技术是否适用于掌骨和指骨的截骨矫形术。
本病例系列包括11例指骨或掌骨畸形排列或畸形愈合的患者。采用MDH技术进行截骨矫形术。随访检查包括术后2至22个月期间的频繁临床评估和影像学检查。
在所有病例中，采用MDH技术进行计划的截骨术在技术上是可行的。除1例钻头断裂外，未记录到术中或术后并发症。所有进行的截骨术平均在6周内愈合至放射学骨痂形成。在所有病例中均取得了满意的结果。
本研究是首次在手外科中测试MDH截骨术。我们证明了MDH对于掌骨和指骨畸形的截骨矫形术是可行的。优点包括在不同角度进行截骨术具有极佳的可行性、精确的操作、降低的附带损伤风险以及进行关节内截骨术的灵活性。
