Del Core Michael, Beckwith Terri, Phillips Lee, Ezaki Marybeth, Stutz Chris, Oishi Scott N
Texas Scottish Rite Hospital for Children.
Children's Orthopaedic and Scoliosis Surgery Associates LLP, Tampa, FL.
J Pediatr Orthop. 2020 Apr;40(4):e306-e311. doi: 10.1097/BPO.0000000000001504.
Madelung deformity arises from a partial distal radial growth disturbance in combination with an abnormal hypertrophic ligament spanning the volar radius and carpus, termed, the Vickers ligament. The purpose of this study is to report long-term clinical and radiographic outcomes following Vickers ligament release and distal radial physiolysis in a population of skeletally immature patients with symptomatic Madelung deformity.
Medical records were retrospectively reviewed of patients with Madelung deformity surgically treated between 1994 and 2005. All eligible patients who underwent a Vickers ligament release and distal radial physiolysis were contacted and invited to return to the clinic for follow-up.
Six patients (8 wrists) with Madelung deformity underwent Vickers ligament release and distal radial physiolysis. All were white females with a mean age at initial presentation of 11.4 years (10 to 12.8 y). Mean age at the time of initial surgery was 12.0 years (10.0 to 14.5 y). The median follow-up time was 10.6 years (5.8 to 21.9 y) and the average age at last follow-up was 23.1 years (17.5 to 32.2 y). Pain alone or in combination with concerns for deformity was the chief complaint in 6 of 8 of the wrists. At 1 year of clinical follow-up, 7 of 8 wrists were reported to be pain-free, and 6 of the 8 were noted to be completely pain-free at last follow-up. Motion in flexion, extension, pronation, supination, radial, or ulnar deviation was similar between the preoperative status and long-term follow-up. The average preoperative ulnar tilt was 35.1 degrees (SD: 8.5 degrees), average preoperative lunate subsidence was 1.9 degrees (SD: 1.8 degrees), and average preoperative palmar carpal displacement was 21.9 degrees (SD: 2.9 degrees). At the final follow-up, there was a large progression in lunate subsidence, but minimal change in ulnar tilt and palmar carpal displacement. At last clinical follow-up, 2 of the 6 patients had undergone a subsequent procedure including 1 radial dome osteotomy and 1 ulnar shortening osteotomy.
In the skeletally immature patient population with Madelung deformity with growth potential remaining, distal radial physiolysis and Vickers ligament release is associated with relief of pain, preservation of motion, and, a reasonable rate of reoperation.
This was a therapeutic study.
Level II.
马德隆畸形源于桡骨远端部分生长紊乱，同时伴有跨越桡骨掌侧与腕骨的异常肥厚韧带，即维氏韧带。本研究的目的是报告对有症状的马德隆畸形骨骼未成熟患者进行维氏韧带松解和桡骨远端骨骺松解术后的长期临床及影像学结果。
回顾性分析1994年至2005年接受手术治疗的马德隆畸形患者的病历。联系所有接受维氏韧带松解和桡骨远端骨骺松解的符合条件患者，并邀请他们返回诊所进行随访。
6例（8腕）马德隆畸形患者接受了维氏韧带松解和桡骨远端骨骺松解。所有患者均为白人女性，初次就诊时平均年龄为11.4岁（10至12.8岁）。初次手术时的平均年龄为12.0岁（10.0至14.5岁）。中位随访时间为10.6年（5.8至21.9年），最后一次随访时的平均年龄为23.1岁（17.5至32.2岁）。8个腕关节中有6个的主要诉求是单独疼痛或伴有对畸形的担忧。在临床随访1年时，8个腕关节中有7个报告无痛，最后一次随访时8个中有6个完全无痛。术前与长期随访之间，屈伸、旋前、旋后、桡偏或尺偏的活动度相似。术前平均尺偏角为35.1度（标准差：8.5度），术前平均月骨下沉为1.9度（标准差：1.8度），术前平均腕骨掌侧移位为21.9度（标准差：2.9度）。在最后一次随访时，月骨下沉有较大进展，但尺偏角和腕骨掌侧移位变化极小。在最后一次临床随访时，6例患者中有2例接受了后续手术，包括1例桡骨穹窿截骨术和1例尺骨短缩截骨术。
对于仍有生长潜力的骨骼未成熟马德隆畸形患者，桡骨远端骨骺松解和维氏韧带松解可缓解疼痛、保留活动度，且再次手术率合理。
这是一项治疗性研究。
二级。
