Farías-Cisneros E, Kaufman C L, Scheker L R
Orthopedics, Hand Surgery and Microsurgery. Centro Médico ABC Santa Fe. Ciudad de México. México.
Christine M Kleinert Institute for Hand and Microsurgery. Louisville, KY, EE. UU.
Acta Ortop Mex. 2018 Sep-Oct;32(5):245-250.
Ulnar shortening (US) is used for treatment of ulnar abutment, early osteoarthrosis (OA) and distal radioulnar joint (DRUJ) instability. However, it has never been strongly advocated as a mid-stage procedure to slow OA progression and reduce requirement of secondary DRUJ procedures. The study aim was to determine if a specific sigmoid notch type is likely to lead to DRUJ replacement after US.
A retrospective study of 119 patients (124 wrists) with DRUJ painful early osteoarthritis, ulnar abutment and DRUJ instability that underwent US was performed. The goals of osteotomy were to decrease pain and slow the initiation or progression of OA. Sigmoid notch type, previous trauma, bone healing time, pain relief, ulnar variance and conversion to DRUJ arthroplasty were analyzed.
Of the 124 wrists studied, bone healing took 3.33 months of average (union rate 98.3%). Sigmoid notch type distribution was 55.6% for type 1, 25.8% for type 2, and 18.5% for type 3. Of the patients with pain after US, 37 had hardware removal and 13 required a DRUJ semi-constrained arthroplasty. Even though analysis did not show any statistically significant correlation, a slight trend towards association of sigmoid notch type 3 with conversion to DRUJ arthroplasty was found.
US has a role in treatment of DRUJ pathology, and its use may delay the need for DRUJ secondary procedures, protecting the native joint. A specific sigmoid notch type does not present risk for OA and does not appear to be related to conversion to DRUJ arthroplasty. Type of study: Therapeutic.
尺骨短缩术（US）用于治疗尺骨撞击、早期骨关节炎（OA）和桡尺远侧关节（DRUJ）不稳。然而，它从未被大力提倡作为减缓OA进展和减少二次DRUJ手术需求的中期手术。本研究的目的是确定特定的乙状切迹类型是否可能导致在尺骨短缩术后进行DRUJ置换。
对119例（124腕）患有DRUJ疼痛性早期骨关节炎、尺骨撞击和DRUJ不稳并接受尺骨短缩术的患者进行了一项回顾性研究。截骨术的目标是减轻疼痛并减缓OA的起始或进展。分析了乙状切迹类型、既往创伤、骨愈合时间、疼痛缓解、尺骨长度差异以及转为DRUJ关节成形术的情况。
在研究的124个腕关节中，骨愈合平均耗时3.33个月（愈合率98.3%）。乙状切迹类型分布为：1型占55.6%，2型占25.8%，3型占18.5%。在尺骨短缩术后仍有疼痛的患者中，37例取出了内固定装置，13例需要进行DRUJ半限制性关节成形术。尽管分析未显示任何统计学上的显著相关性，但发现3型乙状切迹与转为DRUJ关节成形术之间存在轻微的关联趋势。
尺骨短缩术在DRUJ病变的治疗中具有作用，其应用可能会延迟DRUJ二次手术的需求，保护原生关节。特定的乙状切迹类型不会带来OA风险，且似乎与转为DRUJ关节成形术无关。研究类型：治疗性研究。
