Zhang Yiyang, Grewal Ruby, Vergouwen Martina, Lu Steve, White Neil
Pan Am Clinic, Winnipeg, Manitoba, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Division of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada.
J Hand Surg Am. 2025 Jan;50(1):104.e1-104.e7. doi: 10.1016/j.jhsa.2023.06.001. Epub 2023 Jul 12.
Ulnar shortening osteotomy (USO) is commonly performed to alleviate pathologies causing ulnar-sided wrist pain. Surgical complications include nonunion and hardware removal, with rates up to 18% and 45%, respectively. The primary objective of the study was to report the overall complication rate of USO. The secondary objective was to identify risk factors for complications.
A retrospective multicenter cohort review was undertaken, including six Canadian cities over a 6-year period (January 2013-December 2018). Chart review was used to collect demographic data, surgical technique, implant used, and postoperative complications. Descriptive statistics of demographics and operative characteristics, including plate positioning, type of osteotomy, plate type, and ulnar variance (mm), were analyzed. Univariate analyses were used to select predictor variables for nonunion and hardware removal. These predictor variables were then entered into an adjusted multivariable logistic regression model.
A total of 361 USOs were performed. Mean age was 46 ± 16 years (60.7% men). The overall complication rate was 37.1%, hardware removal rate was 29.6%, and nonunion rate was 9.4%. There was a workers' compensation claim associated with 21.6% of all complications, and it was a risk factor for both hardware removal (odds ratio [OR] = 3.81) and nonunion (OR = 2.88). Neither smoking nor diabetes was associated with complication rates. Seventy percent of plates were placed volarly, 25.5% dorsally, and 3.9% directly ulnar. Osteotomies were oblique in 83.7% of cases and transverse in 15.5%. Adjusted multivariate regression analysis revealed that younger age (OR = 0.98) was a risk factor for hardware removal and male sex (OR = 2.49) was a risk factor for nonunion. A surgical factor associated with hardware removal was direct ulnar plate placement (OR = 9.93). No surgical factors were associated with nonunions.
There are substantial rates of complications with USOs. Direct ulnar plate placement should be avoided. Patients should be thoroughly counseled on the risks of complications prior to proceeding with USO.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
尺骨短缩截骨术（USO）常用于缓解引起尺侧腕部疼痛的病症。手术并发症包括骨不连和内固定取出，发生率分别高达18%和45%。本研究的主要目的是报告USO的总体并发症发生率。次要目的是确定并发症的危险因素。
进行了一项回顾性多中心队列研究，涵盖加拿大六个城市，为期6年（2013年1月至2018年12月）。通过病历审查收集人口统计学数据、手术技术、使用的植入物和术后并发症。分析了人口统计学和手术特征的描述性统计数据，包括钢板位置、截骨类型、钢板类型和尺骨长度差异（毫米）。单因素分析用于选择骨不连和内固定取出的预测变量。然后将这些预测变量纳入调整后的多变量逻辑回归模型。
共进行了361例USO手术。平均年龄为46±16岁（男性占60.7%）。总体并发症发生率为37.1%，内固定取出率为29.6%，骨不连率为9.4%。所有并发症中有21.6%与工伤赔偿申请有关，这是内固定取出（比值比[OR]=3.81）和骨不连（OR=2.88）的危险因素。吸烟和糖尿病均与并发症发生率无关。70%的钢板置于掌侧，25.5%置于背侧，3.9%直接置于尺侧。83.7%的病例截骨为斜行，15.5%为横行。调整后的多变量回归分析显示，年龄较小（OR=0.98）是内固定取出的危险因素，男性（OR=2.49）是骨不连的危险因素。与内固定取出相关的手术因素是钢板直接置于尺侧（OR=9.93）。没有手术因素与骨不连相关。
USO手术有较高的并发症发生率。应避免钢板直接置于尺侧。在进行USO手术前，应向患者充分告知并发症的风险。
研究类型/证据水平：治疗性IV级。
