Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Sungnam, 13620, South Korea.
Sci Rep. 2018 Jun 29;8(1):9891. doi: 10.1038/s41598-018-28060-2.
Ulnar impaction syndrome (UIS) is a common source of ulnar-sided wrist pain, yet not all cases of radiographic ulnar impaction are symptomatic. We retrospectively analyze clinical or radiologic factors that affect prognoses of conservative treatment for idiopathic UIS. A total of 114 patients who had been diagnosed with UIS were treated with 6 weeks of short arm orthosis followed by formal physiotherapy for 6 weeks, with lifestyle modification to limit aggravating movements. The response to treatment, including pain numeric rating scale on an ulnar provocation test, grip strength, Disability of the Arm, Shoulder, and Hand score (DASH), was assessed at 24-week follow-up. For the 24-week follow-up, 29 patients (25%) underwent ulnar shortening osteotomy due to persistent symptoms after conservative treatment, and 18 (16%) patients had pain scores of greater than 5, but they had not undergone surgery. After controlling for confounding variables, female gender (odds ratio (OR) 1.39), duration of symptom (OR 1.27), high pain NRS score on provocation test (OR 1.45), and enhanced carpal or distal ulna bone on MRI (OR 1.82) were associated with a higher likelihood of treatment failure. Knowledge of the factors offers physicians insight into predicting prognoses and helps patients set realistic expectations.
尺侧撞击综合征（UIS）是尺侧腕部疼痛的常见原因，但并非所有尺骨撞击的放射影像学表现都有症状。我们回顾性分析了影响特发性 UIS 保守治疗预后的临床或影像学因素。共有 114 例被诊断为 UIS 的患者接受了 6 周的短臂矫形器治疗，随后进行了 6 周的正式物理治疗，并改变生活方式以限制加重病情的运动。在 24 周的随访时，根据尺骨激发试验的疼痛数字评分量表、握力、手臂、肩部和手残疾（DASH）评分评估治疗反应。对于 24 周的随访，29 例（25%）患者由于保守治疗后持续存在症状而接受了尺骨缩短截骨术，18 例（16%）患者疼痛评分大于 5，但未接受手术。在控制混杂变量后，女性（比值比（OR）1.39）、症状持续时间（OR 1.27）、激发试验时较高的疼痛 NRS 评分（OR 1.45）和增强的腕骨或尺骨远端骨在 MRI 上（OR 1.82）与治疗失败的可能性更高相关。了解这些因素可以让医生深入了解预测预后，并帮助患者设定现实的期望。
