Mittal Samarth, Garg Bhavuk, Mehta Nishank, Kumar Vijay, Kotwal Prakash
Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre (AIIMS).
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India.
J Pediatr Orthop. 2020 Oct;40(9):509-514. doi: 10.1097/BPO.0000000000001606.
The choice of surgical procedure in severe (Bayne and Klug types 3 and 4) radial longitudinal deficiency (RLD) is contentious. Existing studies have reported varying results with both centralization and radialization procedures. The purpose of this study was to compare the clinical and radiologic outcome of radialization and centralization procedures at a short-to-intermediate-term follow-up for the treatment of types 3 and 4 RLD.
Fourteen patients with 17 affected limbs having types 3 or 4 RLD were recruited in this prospective, randomized, controlled trial. After initial application of successive casts for soft tissue distraction, patients were randomized to 2 wrist alignment procedures-centralization and radialization. Clinical and radiologic parameters recorded at stipulated intervals until a final follow-up of 24 months included hand-forearm angle, ulnar bow, forearm length, arm length, total angulation, and range of motion at elbow, wrist, and fingers.
Centralization was performed in 9 affected limbs, whereas radialization was performed in 8 affected limbs. Nine affected limbs had type 4 RLD, and 8 affected limbs had type 3 RLD. There was no significant difference in the hand-forearm angle in the immediate postoperative period. At 3 months, the radiologic hand-forearm angle increased to 19 degrees in the centralization group, while the radialization group showed an average increase to 4 degrees. This increase in the hand-forearm angle continued at 6-, 12-, and 24-month follow-up assessments. Worsening of the deformity was more in the centralization group, as compared with the radialization group. The forearm length also significantly differed in the 2 groups at 6-, 12-, and 24-month follow-up; however, when adjusted for preoperative lengths, the difference was significant only at 12- and 24-month follow-up.
At a short-to-intermediate-term follow-up, radialization fares better than centralization in terms of recurrence of deformity and in terms of affecting the forearm length. Longer follow-up with a larger sample size is needed to draw definitive conclusions.
Level I.
严重（Bayne和Klug 3型和4型）桡骨纵列发育不全（RLD）的手术方式选择存在争议。现有研究报道了中心化和桡侧化手术的不同结果。本研究的目的是比较桡侧化和中心化手术在短期至中期随访中治疗3型和4型RLD的临床和影像学结果。
在这项前瞻性、随机、对照试验中招募了14例患者的17条患侧肢体，均为3型或4型RLD。在最初连续应用石膏进行软组织牵张后，患者被随机分为两种腕关节对线手术——中心化和桡侧化。在规定的时间间隔记录临床和影像学参数，直至最终随访24个月，记录参数包括手-前臂角、尺骨弓、前臂长度、上臂长度、总成角以及肘、腕和手指的活动范围。
9条患侧肢体进行了中心化手术，8条患侧肢体进行了桡侧化手术。9条患侧肢体为4型RLD，8条患侧肢体为3型RLD。术后即刻手-前臂角无显著差异。3个月时，中心化组的影像学手-前臂角增加到19度，而桡侧化组平均增加到4度。在6个月、12个月和24个月的随访评估中，手-前臂角持续增加。与桡侧化组相比，中心化组的畸形恶化更明显。在6个月、12个月和24个月的随访中，两组的前臂长度也有显著差异；然而，在根据术前长度进行调整后，差异仅在12个月和24个月的随访时具有统计学意义。
在短期至中期随访中，就畸形复发和对前臂长度的影响而言，桡侧化比中心化效果更好。需要更大样本量和更长时间的随访才能得出明确结论。
I级
