Otte Jeffrey E, Popp James E, Samora Julie Balch
Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.
Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.
J Hand Surg Am. 2019 Feb;44(2):158.e1-158.e9. doi: 10.1016/j.jhsa.2018.04.033. Epub 2018 Jun 20.
To evaluate the surgical outcomes in a series of Madelung wrists treated with a Vicker ligament release at a young age. We hypothesize that early treatment of Madelung deformity with Vicker ligament release is safe and may minimize progression of deformity.
A retrospective review was performed at a single large pediatric institution from 2013 to 2016 of patients with a diagnosis of Madelung deformity treated with Vicker ligament release and radial physiolysis. Exclusion criteria included patients who were skeletally mature, who underwent osteotomy procedures, or who had incomplete follow-up. Patient demographics were collected, concomitant surgeries were recorded, and outcomes including range of motion and pain were documented. Measurements of standard anteroposterior and lateral radiographs were calculated before and after surgery to monitor radiographic deformity and progression.
Six girls with bilateral Madelung deformity who underwent bilateral Vicker ligament resection and radial physiolysis (12 total wrists) were included. The average age at presentation was 7.5 years (range, 7-9 years), with an average follow-up of 30 months. Reasons for presentation included sports injuries (2), ulnar-sided wrist pain (2), and mild deformity (2). Additional radial and ulnar epiphysiodeses were performed in 2 wrists each. There were no intraoperative complications. Although pain resolved within the first month after surgery for all patients, 2 patients had intermittent unilateral ulnar-sided wrist pain at final follow-up. All patients returned to their presurgery activities. There was no loss of range of motion, and 4 wrists with preoperative supination deficits improved by an average of 17°. Radiographic measurements demonstrated improvement in the radial physeal angle in 10 out of 12 wrists (83%). No patients displayed worsening deformity after surgery. Two patients underwent subsequent procedures.
In patients with early Madelung deformity, Vicker ligament release with radial physiolysis is a safe treatment option that theoretically has the potential to minimize the progression of radiographic deformity.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
评估一系列幼年马德隆腕行维克韧带松解术的手术效果。我们假设早期采用维克韧带松解术治疗马德隆畸形是安全的，且可使畸形进展最小化。
对2013年至2016年在一家大型儿科机构诊断为马德隆畸形并接受维克韧带松解术和桡骨骨骺松解术的患者进行回顾性研究。排除标准包括骨骼成熟、接受截骨手术或随访不完整的患者。收集患者人口统计学资料，记录同期手术情况，并记录包括活动范围和疼痛在内的结果。计算术前和术后标准正位和侧位X线片测量值，以监测影像学畸形及进展情况。
纳入6例双侧马德隆畸形并接受双侧维克韧带切除术和桡骨骨骺松解术的女孩（共12只腕）。就诊时平均年龄为7.5岁（范围7 - 9岁），平均随访30个月。就诊原因包括运动损伤（2例）、尺侧腕部疼痛（2例）和轻度畸形（2例）。另有2只腕各进行了额外的桡骨和尺骨骨骺阻滞术。无术中并发症。尽管所有患者术后第1个月内疼痛均缓解，但最终随访时有2例患者出现间歇性单侧尺侧腕部疼痛。所有患者均恢复至术前活动水平。活动范围无丢失，4例术前旋后功能障碍的腕平均改善了17°。影像学测量显示12只腕中有10只（83%）桡骨骨骺角有所改善。术后无患者出现畸形加重。2例患者接受了后续手术。
对于早期马德隆畸形患者，维克韧带松解术联合桡骨骨骺松解术是一种安全的治疗选择，理论上有可能使影像学畸形进展最小化。
研究类型/证据水平：治疗性研究，证据等级V 。
