Hassan S, Shafafy R, Mohan A, Magnussen P
Epsom and Saint Helier University Hospitals NHS Trust, Carshalton , Surry , UK.
Royal Surrey County Hospital NHS Foundation Trust, Guildford , Surrey , UK.
Ann R Coll Surg Engl. 2019 Mar;101(3):203-207. doi: 10.1308/rcsann.2018.0211. Epub 2019 Jan 30.
Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication.
Twenty patients with previous distal radial fractures were included, who presented with wrist pain and radiologically evident positive ulnar variance secondary to malunion of the distal radius with no significant intercalated instability. Patients were treated with a short oblique ulnar shortening osteotomy, using a Stanley jig and small AO compression plate system. Pre- and postoperative radiographical measurements of inclination, dorsal/volar angulation and ulnar variance were made. Patients were scored pre- and postoperatively using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient-Rated Wrist Evaluation scores by two orthopaedic surgeons. Mean follow-up was 24 months after surgery.
Radiographical analysis revealed a change in the ulnar variance with an average reduction of 5.74 mm. Mean preoperative scores were 61.1 (range 25-95.5) for QuickDASH and 70.4 (range 33-92) for Patient-Rated Wrist Evaluation. At the latest follow-up, mean postoperative QuickDASH scores were 10.6 (range 0-43.2) and 17.2 (range 0-44) for Patient-Rated Wrist Evaluation. Differences in scores after surgery for both QuickDASH and Patient-Rated Wrist Evaluation were statistically significant (P < 0.01).
The ulnar shortening osteotomy is a relatively simple procedure compared with corrective radial osteotomy, with a lower complication profile. In our series, patients showed significant improvement in pain and function by correcting the ulnar variance thus preventing ulna-carpal impaction.
孤立性尺骨短缩截骨术可用于治疗桡骨远端骨折后继发桡骨短缩引起的尺腕撞击。鉴于桡骨远端脆性骨折的增加，认识到治疗桡骨远端骨折后遗症很重要。我们报告了英国针对该适应症进行尺骨短缩截骨术的最大病例系列。
纳入20例既往有桡骨远端骨折的患者，这些患者出现腕部疼痛，且经放射学检查显示因桡骨远端畸形愈合导致尺骨正向变异明显，且无明显的中间不稳定。患者接受短斜行尺骨短缩截骨术，使用斯坦利夹具和小型AO加压钢板系统。术前和术后对倾斜度、背侧/掌侧成角和尺骨变异进行放射学测量。由两名骨科医生术前和术后使用手臂、肩部和手部快速残疾评定量表（QuickDASH）和患者自评腕关节评估评分对患者进行评分。术后平均随访24个月。
放射学分析显示尺骨变异有变化，平均减少5.74毫米。术前QuickDASH平均评分为61.1（范围25 - 95.5），患者自评腕关节评估评分为70.4（范围33 - 92）。在最近一次随访时，术后QuickDASH平均评分为10.6（范围0 - 43.2），患者自评腕关节评估评分为17.2（范围0 - 44）。QuickDASH和患者自评腕关节评估术后评分差异均具有统计学意义（P < 0.01）。
与桡骨矫正截骨术相比，尺骨短缩截骨术是一种相对简单的手术，并发症较少。在我们的系列研究中，患者通过纠正尺骨变异，从而防止尺腕撞击，疼痛和功能有显著改善。
