Service orthopédie 1 et traumatologie, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France.
Service chirurgie et orthopédie de l'enfant, Hôpital Jeanne de Flandres, CHU de Lille, 59000 Lille, France.
Orthop Traumatol Surg Res. 2022 Nov;108(7):103374. doi: 10.1016/j.otsr.2022.103374. Epub 2022 Aug 5.
Madelung's deformity is a rare congenital condition of the wrist that can cause pain, aesthetic concerns, reduced range of motion and grip strength. Currently, there is no consensus on the optimal age for surgery or whether operative procedures can be isolated or combined depending on the extent of the deformity. The main objective of our study was to analyze the postoperative functional clinical results at a minimum of 3-years follow-up in patients operated on for Madelung's deformity. The secondary objectives were (1) comparison of preoperative and postoperative radiographic parameters, and (2) to assess whether certain preoperative radiographic parameters influence the choice of surgical procedure.
The surgery offered at our center achieves clinical and radiological result necessary for long-term activities of daily living, and varies according to the severity of the distal radial deformity.
We carried out a retrospective observational monocentric study including patients operated on between 2004 and 2016. Clinical (VAS, mobility), functional (PRWE score), and radiographic assessments were performed before and after the last follow-up.
The study included 11 patients (12 wrists) with a mean age of 17±7.3 years and a mean follow-up of 8.1 years (4-12.3). The mean VAS was 2.3 (0-6) and the mean PRWE score was 37 (0-108). The mean flexion-extension arc was 134° and that of pronation and supination was 142°. The mean grip strength was 25.8±11.8kg. Four out of 6 radiographic criteria were significantly improved. An isolated radial osteotomy or combined radioulnar osteotomy was performed when the sagittal radial tilt was greater than 30° and protrusion of the lunate greater than 5mm, otherwise below these values, an isolated ulnar osteotomy was performed.
Our center offers surgical management of Madelung's deformity by osteotomy which improves the majority of postoperative radiographic parameters and gives satisfactory clinical and radiographic results after a mean follow-up of 8.1 years. The surgery is influenced by the severity of the distal radial deformity, including protrusion of the lunate and sagittal radial tilt.
IV, Retrospective study.
马德隆畸形是一种罕见的腕部先天性疾病，可引起疼痛、美观问题、活动范围和握力下降。目前，对于手术的最佳年龄以及手术方式（单独或联合）是否取决于畸形的严重程度，尚无共识。本研究的主要目的是分析至少 3 年随访时接受马德隆畸形手术患者的术后功能临床结果。次要目的是：（1）比较术前和术后的影像学参数；（2）评估某些术前影像学参数是否会影响手术方式的选择。
本中心的手术能够实现日常生活活动所需的长期临床和影像学结果，且根据桡骨远端畸形的严重程度而有所不同。
我们进行了一项回顾性单中心研究，纳入了 2004 年至 2016 年间接受手术的患者。在末次随访前后进行了临床（视觉模拟评分法，活动度）、功能（PRWE 评分）和影像学评估。
研究共纳入 11 例（12 腕）患者，平均年龄为 17±7.3 岁，平均随访时间为 8.1 年（4-12.3 年）。平均视觉模拟评分法（VAS）为 2.3（0-6），平均 PRWE 评分为 37（0-108）。平均掌屈-背伸弧为 134°，旋前和旋后弧为 142°。平均握力为 25.8±11.8kg。6 项影像学标准中有 4 项显著改善。当矢状位桡骨倾斜大于 30°和月骨突出大于 5mm 时，行单独桡骨或桡尺骨联合截骨术；否则，当这些值较小时，行单独尺骨截骨术。
本中心采用截骨术治疗马德隆畸形，术后大多数影像学参数得到改善，平均随访 8.1 年后获得了满意的临床和影像学结果。手术方式取决于桡骨远端畸形的严重程度，包括月骨突出和矢状位桡骨倾斜。
IV，回顾性研究。
