Department of Orthopaedic Surgery and Traumatology, Hospital Infantil Universitario Niño Jesús, Madrid.
Department of Orthopaedic Surgery and Traumatology, Hospital Polyclinic Hospital of Vigo, Povisa, Spain.
J Pediatr Orthop. 2022 Aug 1;42(7):e756-e761. doi: 10.1097/BPO.0000000000002191. Epub 2022 Jun 8.
Many operative methods have been reported for the treatment of congenital radioulnar synostosis (CRUS) and their indications remain controversial. The aim of this study is to evaluate the clinical, radiologic, and functional results of the 2-stage derotational osteotomy with periosteal preservation for CRUS in children.
From a total of 102 children with CRUS, a retrospective evaluation of 14 consecutive patients (18 forearms) who underwent 2-stage derotational osteotomy of the distal third radius and proximal third ulna with periosteal preservation, bone segment removal, morselization and grafting and cast immobilization was performed. Children with bilateral involvement and/or pronation (>60 degrees), and substantial functional limitations in daily activities were considered candidates for surgery to obtain the desired position of 0 to 20 degrees of pronation. Electronic medical records, preoperative and postoperative clinical and radiologic examinations were reviewed. Also, functional results and parental satisfaction were assessed and statistically analyzed.
The median age at the time of surgery was 6.87 (5.02 to 11.22) years. The median follow-up was 38.62 (24.79 to 81.20) months. The median preoperative pronation deformity was 80 (70 to 90) degrees, while the final position was 0 (0 to 10) degrees of pronation ( P <0.01). Elbow flexion and extension showed no changes after surgery. All patients successfully achieved union at 8 (6 to 10) weeks. No complications were observed, and no patient required revision surgeries. The ability to perform daily activities improved markedly, and all patients were satisfied with the results of the surgery.
Two-stage double-level intraperiosteal derotational osteotomy is a safe, simple, and effective procedure in children with CRUS with severe deformity and limitation in performing basic daily living activities. Functional improvement and patient satisfaction are total, and so far no complications have been reported.
Level III-treatment study, retrospective comparative study.
先天性尺桡骨融合（CRUS）的治疗方法已有多种报道，但其适应证仍存在争议。本研究旨在评估保留骨膜的 2 期旋转截骨术治疗儿童 CRUS 的临床、放射学和功能结果。
共纳入 102 例 CRUS 患儿，回顾性分析了 14 例连续患儿（18 例前臂）的临床资料，他们接受了保留骨膜的 2 期远端三分之一桡骨和近端三分之一尺骨旋转截骨术，包括骨段切除、碎骨片化和植骨以及石膏固定。双侧受累和/或旋前（>60°）以及日常生活中存在明显功能受限的患儿被认为是手术的候选者，以获得 0 至 20°的旋前位。回顾了电子病历、术前和术后的临床和放射学检查。还评估了功能结果和家长满意度，并进行了统计学分析。
手术时的中位年龄为 6.87 岁（5.02 至 11.22 岁）。中位随访时间为 38.62 个月（24.79 至 81.20 个月）。术前旋前畸形的中位数为 80°（70°至 90°），最终位置为 0°（0°至 10°）的旋前（P<0.01）。手术后肘部屈伸无变化。所有患者均在 8（6 至 10）周内成功愈合。无并发症发生，无患者需要再次手术。日常生活活动能力显著改善，所有患者对手术结果均满意。
对于严重畸形和日常生活活动受限的 CRUS 患儿，2 期双水平骨膜内旋转截骨术是一种安全、简单、有效的方法。功能改善和患者满意度均为总满意度，且目前尚无并发症报告。
III 级-治疗研究，回顾性比较研究。
