SEL chirurgie de la main et du pied, 94, avenue Gustave Delory, 59810 Lesquin, France.
CHRU de Lille, rue du Professeur Emile Laine, 59037 Lille, France.
Hand Surg Rehabil. 2021 Apr;40(2):156-161. doi: 10.1016/j.hansur.2020.10.012. Epub 2020 Nov 5.
Post-traumatic or constitutional ulnar impaction syndrome can be treated by shortening the ulna. This can be achieved by diaphyseal or metaphyseal osteotomy, or by arthroscopic epiphyseal resection. The objective of this study was to compare the results of the diaphyseal shortening osteotomy (USO) and arthroscopic wafer procedure (AWP) of the ulna in this indication. This was a retrospective case series of 33 patients operated for ulnar impaction syndrome by the same surgeon between 1997 and 2017. The diagnosis was made based on pain on the ulnar edge of the wrist with positive provocative tests. Radiographs were made and CT arthrography or MRI were used to confirm the diagnosis. Per-and post-operative assessments were functional (DASH and PRWE scores), clinical (pain, range of motion and grip strength) and radiographic. Diaphyseal ulnar shortening osteotomy (USO) was performed in 9 patients using a volar plate and a cutting guide. Twenty-four patients underwent an arthroscopic wafer procedure. Mean follow-up was 103 ± 8 months in the USO group versus 55 ± 4 months in the AWP group. There was no significant difference between groups in pain levels (1.2/10 in the USO group versus 0.9/10 in the AWP group, p = 0.88), grip strength (39 Kg in the USO group versus 34 Kg in the AWP group, p = 0.27) and PRWE score (5,8/100 in the USO group versus 11,2 in the AWP group, p = 0.34), and DASH score (25/100 in the USO group versus 28 in the AWP group, p = 0.63). The time away from work was long in the USO group than in the AWP group (7.86 months versus 3.75 months) (p = 0.002). Seven patients were reoperated in the USO group (5 plate removal, 1 nonunion and 1 delayed union) versus 3 in the AWP group (1 ECU stabilization, 1 ablation for painful ulnar styloid due to nonunion and 1 wrist denervation) (p = 0.0004). The study found no clinical differences between these two techniques except the return to work time. In our series, diaphyseal USO was associated with a greater number of reoperations than the AWP.
创伤后或特发性尺骨撞击综合征可以通过缩短尺骨来治疗。这可以通过骨干或干骺端截骨术，或通过关节镜下骺板切除术来实现。本研究的目的是比较尺骨干缩短截骨术（USO）和关节镜下骨片切除术（AWP）在该适应证中的结果。这是一项回顾性病例系列研究，共纳入 33 例由同一位外科医生于 1997 年至 2017 年期间因尺骨撞击综合征而接受手术的患者。该诊断基于腕尺侧边缘疼痛，并通过阳性激发试验证实。拍摄 X 线片，并使用 CT 关节造影或 MRI 来确认诊断。进行术前和术后评估，包括功能（DASH 和 PRWE 评分）、临床（疼痛、活动范围和握力）和影像学。9 例患者采用掌侧钢板和切割导向器行尺骨干缩短截骨术（USO）。24 例患者行关节镜下骨片切除术。USO 组的平均随访时间为 103±8 个月，AWP 组为 55±4 个月。两组在疼痛水平（USO 组 1.2/10，AWP 组 0.9/10，p=0.88）、握力（USO 组 39 Kg，AWP 组 34 Kg，p=0.27）和 PRWE 评分（USO 组 5.8/100，AWP 组 11.2，p=0.34）以及 DASH 评分（USO 组 25/100，AWP 组 28，p=0.63）方面无显著差异。USO 组的缺勤时间长于 AWP 组（7.86 个月比 3.75 个月）（p=0.002）。USO 组有 7 例患者再次手术（5 例钢板取出，1 例骨不连，1 例延迟愈合），而 AWP 组有 3 例（1 例 ECU 稳定术，1 例因骨不连导致的尺骨茎突疼痛消融术，1 例腕部神经切断术）（p=0.0004）。除了重返工作岗位的时间外，本研究未发现这两种技术之间存在临床差异。在我们的系列中，尺骨干 USO 与更多的再手术相关，而 AWP 则较少。
