Service de Chirurgie Pédiatrique, CHU of Rennes, boulevard de Bulgarie, 35203 Rennes, France.
Service de Chirurgie Pédiatrique, CHUSO Tours-Clocheville, 49, boulevard Béranger, 37000 Tours. France.
Orthop Traumatol Surg Res. 2020 Nov;106(7):1339-1343. doi: 10.1016/j.otsr.2020.03.036. Epub 2020 Sep 19.
Madelung's deformity is rare. Treatment often consists in radial or ulnar osteotomy, Vickers' ligament resection or ulnar epiphysiodesis. The present multicenter retrospective study reports clinical and radiographic results in various surgeries. The study hypothesis was that early surgery improves outcome.
Files were analyzed for 36 children (47 wrists) operated on between 1998 and 2015. Mean age at diagnosis was 12 years (range, 6-15 years). Mean follow-up was 7.2 years (range, 2-17.4 years). Two age groups were distinguished: 6-11 and 12-17 years. Endpoints were esthetic, functional (Mayo Wrist Score: MWS) and radiographic [lunate fossa angle (LFA), radial height (RH), lunatum cover rate (LCR), ulnar head translation (UHT), lunatum ascension (LA)]. Techniques mainly comprised distal radius osteotomy (DRO) with ulnar shortening osteotomy (USO), and Vickers' ligament resection (VR), either isolated or associated to osteotomy.
Age at surgery guided choice of technique, but did not impact results. VR gave better functional results when performed in young children; it was mainly performed in the 6-11 years age group, providing very satisfactory results (7 out of 8 wrists) with excellent function (7 out of 8), without improving radiographic parameters; in the 12-17 years age group, even when esthetic results were excellent, functional results were only good-to-acceptable (3 out of 5 wrists) and 1 result was poor. DRO+USO was mainly performed in the 12-17 years age group, with very satisfactory or satisfactory results (8 out of 10 wrists) and excellent function (6 out of 10). DRO+USO appeared to be an option of choice, significantly improving radiographic parameters and correcting the deformity (24.5° improvement in LFA (p=0.0033) and 36.2% improvement in LCR (p=0.0103)). DRO+USO+VR was mainly implemented in the 12-17 years age group, with very satisfactory results (3 out of 4 wrists) and excellent-to-good MWS in most cases (3 out of 4), but without significant radiographic improvement.
Esthetic and functional results were comparable regardless of age, except for VR, which gave better functional results in the 6-11 years age group, but without significant difference.
The present study showed that, regardless of children's age, surgery provided esthetic, functional and radiographic benefit, although no decision-tree could be drawn up.
IV.
Madelung 畸形较为罕见。治疗方法通常包括桡骨或尺骨切开术、Vickers 韧带切除术或尺骨骨骺切除术。本多中心回顾性研究报告了各种手术的临床和影像学结果。研究假设是早期手术可以改善结果。
对 1998 年至 2015 年间接受手术的 36 名儿童（47 个腕关节）的病历进行了分析。诊断时的平均年龄为 12 岁（范围：6-15 岁）。平均随访时间为 7.2 年（范围：2-17.4 年）。根据年龄将患者分为两组：6-11 岁和 12-17 岁。终点为美观、功能（Mayo 腕关节评分：MWS）和影像学[月骨窝角（LFA）、桡骨高度（RH）、月骨覆盖率（LCR）、尺骨头位移（UHT）、月骨上升（LA）]。主要技术包括桡骨远端切开术（DRO）联合尺骨缩短截骨术（USO）和 Vickers 韧带切除术（VR），可以单独进行，也可以与切开术联合进行。
手术年龄指导技术选择，但不影响结果。VR 在儿童早期进行时可获得更好的功能结果；它主要在 6-11 岁年龄组中进行，提供了非常满意的结果（8 个腕关节中的 7 个），功能非常好（8 个腕关节中的 7 个），但影像学参数无改善；在 12-17 岁年龄组中，即使美观结果非常满意，功能结果也仅为好到可接受（5 个腕关节中的 3 个），1 个结果为差。DRO+USO 主要在 12-17 岁年龄组中进行，获得了非常满意或满意的结果（10 个腕关节中的 8 个）和优秀的功能（10 个腕关节中的 6 个）。DRO+USO 似乎是一种选择，可显著改善影像学参数并矫正畸形（LFA 改善 24.5°（p=0.0033），LCR 改善 36.2%（p=0.0103））。DRO+USO+VR 主要在 12-17 岁年龄组中实施，获得了非常满意的结果（4 个腕关节中的 3 个），大多数情况下 MWS 为优秀到良好（4 个腕关节中的 3 个），但影像学无明显改善。
无论年龄大小，美观和功能结果都可以得到改善，除了 VR，它在 6-11 岁年龄组中可获得更好的功能结果，但无显著差异。
本研究表明，无论儿童年龄大小，手术都能提供美观、功能和影像学上的益处，尽管无法制定决策树。
IV。
