Department of Pediatric Orthopaedics, Children's Hospital of Fudan University, Shanghai, China.
Department of Pediatric Orthopaedics, Hainan Women and Children's Medical Center, Haikou, China.
J Bone Joint Surg Am. 2020 Jun 17;102(12):1066-1074. doi: 10.2106/JBJS.19.01444.
Ulnar lengthening is a consensus treatment for hereditary multiple exostoses with radial head dislocation in pediatric patients; however, the optimal amount of ulnar lengthening remains unclear. It is necessary to look for a parameter to decide the amount of ulnar lengthening that will avoid recurrence and complications. The purpose of the present study was to confirm that proportional ulnar length (ulnar length/radial length) can be used as a scale for ulnar lengthening in pediatric patients.
The normal lengths of the ulna and radius in the pediatric population were measured in different age groups. The proportional ulnar length was calculated as ulnar length/radial length in each group. Thirty forearms in 26 patients with radial head dislocation were treated with ulnar lengthening and deformity correction. The goal of ulnar lengthening was to recover the normal proportional ulnar length. The function of the forearm was evaluated at the time of the latest follow-up. The preoperative and postoperative values for radial bowing, radioarticular angle, ulnar variance, and carpal slip were also compared.
The value of proportional ulnar length in the normal population consistently averaged approximately 1.1. In all cases, proportional ulnar length recovered to the normal value of 1.1. Reduction of the dislocated radial head was achieved in 28 forearms (93%); in 16 of these forearms, good-quality reduction was achieved and no recurrence of radial head dislocation was observed during follow-up. The function of the forearm improved markedly (p < 0.001). Ulnar variance improved from 2.51 to -0.79 cm (p < 0.001). Radial deformities improved according to measurements of radial bowing and the radioarticular angle (p < 0.001). All parents were satisfied with the postoperative appearance and function of the forearm.
Proportional ulnar length could be used as a scale to decide the amount of ulnar lengthening for radial head dislocation in pediatric patients with hereditary multiple exostoses. Ulnar lengthening according to proportional ulnar length and deformity correction can prevent recurrence of ulnar variance and avoid impingement of the wrist.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
尺骨延长术是治疗儿童遗传性多发性外生骨疣伴桡骨头脱位的共识治疗方法；然而，尺骨延长的最佳长度仍不清楚。有必要寻找一个参数来决定尺骨延长的长度，以避免复发和并发症。本研究的目的是证实比例性尺骨长度（尺骨长度/桡骨长度）可作为儿童患者尺骨延长的尺度。
在不同年龄组中测量儿童人群中尺骨和桡骨的正常长度。在每组中计算尺骨长度/桡骨长度的比例性尺骨长度。26 例桡骨头脱位患者的 30 例前臂接受尺骨延长和畸形矫正治疗。尺骨延长的目标是恢复正常的比例性尺骨长度。在最近的随访时评估前臂的功能。还比较了术前和术后桡骨弯曲、桡腕关节角、尺骨差异和腕骨滑移的数值。
正常人群中比例性尺骨长度的数值始终平均约为 1.1。所有病例中，比例性尺骨长度均恢复到正常的 1.1 值。28 例前臂（93%）实现了脱位桡骨头的复位；在这 16 例前臂中，实现了良好质量的复位，在随访过程中未观察到桡骨头再脱位。前臂的功能明显改善（p<0.001）。尺骨差异从 2.51 改善至-0.79cm（p<0.001）。根据桡骨弯曲和桡腕关节角的测量，桡骨畸形得到改善（p<0.001）。所有家长均对前臂的术后外观和功能满意。
比例性尺骨长度可作为决定遗传性多发性外生骨疣伴桡骨头脱位儿童患者尺骨延长量的尺度。根据比例性尺骨长度和畸形矫正进行尺骨延长可以预防尺骨差异的复发，并避免腕部撞击。
治疗性 IV 级。请参阅作者说明，以获取完整的证据等级描述。
