Peking University Fourth School of Clinical Medicine, Beijing, China.
Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China.
Orthop Surg. 2022 Jun;14(6):1229-1234. doi: 10.1111/os.13226. Epub 2022 May 7.
To describe the modified mobilization surgery technique that uses a free vascularized fascia lata graft as the interposition graft, and to evaluate the outcome of this procedure in treating congenital radioulnar synostosis (CRUS).
Eleven patients (eight boys and three girls with an average age of 6.0 years) were treated using this procedure between 2012 and 2017 in our institution. Five bilateral cases (four left forearms and one right forearm were treated), and six unilateral cases (three left forearms and three right forearms) were included. All 11 cases were treated with mobilization procedure with free vascularized fascia lata as the interposition graft, and were followed-up for an average of 2.2 years (range, 2-4 years). The parental satisfaction, postoperative ankylosis at proximal radioulnar joint, and active range of forearm rotation motion (measured by physical examination) were evaluated at the last follow-up.
The average preoperative fixed pronation angle was 67.3° (range, 20°-90°). Ipsilateral thumb hypoplasia was noted in one case, and cleft palate and bilateral thumb hypoplasia were noted in one case; none of the patients had a family history of congenital radioulnar synostosis. Pronation and supination splints were used 3 days after the operation and were worn every night for 4-6 months postoperatively. Active and passive rehabilitation for elbow flexion and forearm rotation was initiated 4 weeks postoperatively. All patients were followed up for at least 2 years (average, 26 months; range, 24-48 months). The average forearm pronation range was 39° (range, 20°-60°), and the average forearm supination range was 33.2° (range, 10°-60°) at the latest follow-up. Re-ankylosis occurred in one case. An osseous bridge developed between the radius and ulna at the osteotomy site in one case. Radial nerve paralysis developed in two cases and spontaneously resolved 2 months later. Plate breakage was noted in one case 9 weeks postoperatively; however, union was achieved 7 months later.
Mobilization of proximal radioulnar synostosis using a free vascularized fascia lata graft as the interposition graft may prevent re-ankylosis and restore the forearm rotation function, making it a good option for the surgical treatment of CRUS.
描述一种改良的动员手术技术，该技术使用游离血管化阔筋膜作为中间移植物，评估该技术治疗先天性尺桡骨融合（CRUS）的效果。
2012 年至 2017 年，我院共收治 11 例（8 例男性，3 例女性，平均年龄 6.0 岁）采用该方法治疗的患者。其中 5 例为双侧病例（4 例为左前臂，1 例为右前臂），6 例为单侧病例（3 例为左前臂，3 例为右前臂）。所有 11 例均采用游离血管化阔筋膜作为中间移植物进行动员手术，平均随访 2.2 年（2-4 年）。末次随访时，评估父母满意度、近侧尺桡关节术后僵硬和前臂旋转运动的主动活动范围（体格检查测量）。
术前平均固定旋前角度为 67.3°（20°-90°）。1 例同侧拇指发育不良，1 例腭裂伴双侧拇指发育不良，均无先天性尺桡骨融合家族史。术后第 3 天使用旋前和旋后夹板，术后 4-6 个月每晚佩戴。术后 4 周开始进行肘部屈伸和前臂旋转的主动和被动康复治疗。所有患者均随访至少 2 年（平均 26 个月；范围 24-48 个月）。末次随访时，平均前臂旋前范围为 39°（20°-60°），平均前臂旋后范围为 33.2°（10°-60°）。1 例再发僵硬，1 例在骨切开部位桡骨和尺骨之间形成骨桥，2 例桡神经麻痹，2 个月后自发缓解。1 例术后 9 周出现钢板断裂，但 7 个月后愈合。
使用游离血管化阔筋膜作为中间移植物动员近端尺桡骨融合可防止再僵硬并恢复前臂旋转功能，是治疗 CRUS 的一种较好的手术选择。
