Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
J Hand Surg Asian Pac Vol. 2021 Mar;26(1):118-125. doi: 10.1142/S2424835521710016.
Congenital radioulnar synostosis with posterior dislocation of the radial head remains challenging to treat. We describe a three-step treatment method that combines radial shaft osteotomy with a custom-made device, ulnar shaft osteotomy, and local adipofascial flap elevation procedures. For posterior radial head dislocation treatment, osteotomy near the proximal radius cannot recover physiological rotation of the radial head. Thus, we chose a precise radial shaft osteotomy with a custom-made device according to preoperative planning based on three-dimensional evaluation of the bone deformation. Performing radial shaft osteotomy alone, however, may not be enough to achieve sufficient supination range of motion. We, therefore, also performed ulnar shaft osteotomy. Finally, we elevated the local adipofascial flap to prevent re-adhesion. In three patients, the range of motion of the elbow improved postoperatively. In conclusion, our three-step method does not require a microsurgical technique and is easy to perform.
先天性桡尺骨融合伴桡骨头后脱位的治疗仍具有挑战性。我们描述了一种三步治疗方法，该方法结合了桡骨干切开术和定制设备、尺骨干切开术以及局部脂肪筋膜瓣提升术。对于桡骨头后脱位的治疗，近桡骨干的切开术不能恢复桡骨头的生理旋转。因此，我们根据术前三维骨畸形评估，选择了根据术前规划的精确桡骨干切开术和定制设备。然而，单独进行桡骨干切开术可能不足以获得足够的旋后活动范围。因此，我们还进行了尺骨干切开术。最后，我们抬起局部脂肪筋膜瓣以防止再次粘连。在 3 名患者中，术后肘关节活动度均得到改善。总之，我们的三步法不需要显微外科技术，操作简单。
