骨-髌腱-骨移植物重建骨间膜治疗慢性 Essex-Lopresti 损伤：平均随访超过 10 年的结果。

Late Reconstruction of the Interosseous Membrane with Bone-Patellar Tendon-Bone Graft for Chronic Essex-Lopresti Injuries: Outcomes with a Mean Follow-up of Over 10 Years.

机构信息

Philadelphia Hand to Shoulder Center, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.

Darden School of Business, University of Virginia, Charlottesville, Virginia.

出版信息

J Bone Joint Surg Am. 2018 Mar 7;100(5):416-427. doi: 10.2106/JBJS.17.00820.

DOI:10.2106/JBJS.17.00820

PMID:29509619

Abstract

BACKGROUND

The purpose of this study was to report our long-term outcomes following reconstruction of the forearm interosseous membrane (IOM) with bone-patellar tendon-bone (BPTB) graft for treatment of chronic Essex-Lopresti injuries.

METHODS

We identified 33 patients who underwent IOM reconstruction with BPTB graft for chronic Essex-Lopresti injuries over a 20-year treatment interval. Twenty male and 13 female patients, with a mean age of 42.1 years (range, 19 to 73 years) and a minimum follow-up interval of 5 years, were included. Preinjury clinical examination and radiographic measurements were obtained from records for comparison with prospectively collected data. Additional functional outcome data collected postoperatively included QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]), modified Mayo wrist (MMW), and Broberg-Morrey elbow function scores.

RESULTS

IOM reconstruction was performed at a mean interval (and standard deviation) of 44.9 ± 60.0 months (range, 6.4 to 208 months) from the time of the initial injury. At a mean follow-up of 10.9 ± 4.4 years (range, 5.5 to 24.2 years), significant improvements were observed in mean elbow flexion-extension arc (+13° [95% confidence interval (CI), 4° to 22°]; p = 0.005), wrist flexion-extension arc (+19° [95% CI, 4° to 34°]; p = 0.016), forearm pronation-supination (+23° [95% CI, 8° to 39°]; p = 0.004), and grip strength (+25% of that of the contralateral side [95% CI, 18% to 32% of contralateral side]; p < 0.001). Improvements in ulnar variance were sustained over the long term from +3.9 mm (95% CI, 3.2 to 4.6 mm) preoperatively to -1.6 mm (95% CI, -2.3 to -0.9 mm) immediately postoperatively and -1.1 mm (95% CI, -1.8 to -0.4 mm) at the time of the final follow-up (p < 0.001). The mean QuickDASH, MMW, and Broberg-Morrey scores were 29.8 (range, 5 to 61), 82.7 (range, 60 to 100), and 91.6 (range, 64 to 100), respectively.

CONCLUSIONS

IOM reconstruction with a BPTB graft is an effective treatment option for chronic Essex-Lopresti injuries, with satisfactory clinical and functional outcomes over the long term.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

本研究旨在报告我们使用骨-髌腱-骨（BPTB）移植物重建前臂骨间膜（IOM）治疗慢性 Essex-Lopresti 损伤的长期结果。

方法

我们在 20 年的治疗间隔内，共发现 33 例接受 IOM 重建治疗慢性 Essex-Lopresti 损伤的患者。患者包括 20 名男性和 13 名女性，平均年龄为 42.1 岁（范围：19 岁至 73 岁），最小随访时间为 5 年。从记录中获取了损伤前的临床检查和影像学测量值，并与前瞻性收集的数据进行了比较。术后还收集了额外的功能预后数据，包括 QuickDASH（手臂、肩部和手残疾程度的缩写版本[DASH]）、改良 Mayo 腕部（MMW）和 Broberg-Morrey 肘部功能评分。

结果

IOM 重建的时间是在初始损伤后的平均（标准差）44.9 ± 60.0 个月（范围：6.4 至 208 个月）进行。平均随访 10.9 ± 4.4 年（范围：5.5 至 24.2 年）后，观察到肘部屈伸弧的平均改善（+13°[95%置信区间（CI），4°至 22°]；p=0.005）、腕部屈伸弧的平均改善（+19°[95% CI，4°至 34°]；p=0.016）、前臂旋前-旋后弧的平均改善（+23°[95% CI，8°至 39°]；p=0.004）和握力的平均改善（对侧握力的 25%[95% CI，对侧侧 18%至 32%]；p<0.001）。长期随访中，尺侧偏斜的改善得以维持，从术前的+3.9 毫米（95% CI，3.2 毫米至 4.6 毫米）到术后即刻的-1.6 毫米（95% CI，-2.3 毫米至-0.9 毫米）和最终随访时的-1.1 毫米（95% CI，-1.8 毫米至-0.4 毫米）（p<0.001）。平均 QuickDASH、MMW 和 Broberg-Morrey 评分分别为 29.8（范围：5 至 61）、82.7（范围：60 至 100）和 91.6（范围：64 至 100）。