Reck Alexander, Pillukat Thomas, van Schoonhoven Jörg
Klinik für Handchirurgie, Rhön Klinikum Campus Bad Neustadt, Bad Neustadt, Germany.
Handchir Mikrochir Plast Chir. 2024 Jun;56(3):235-241. doi: 10.1055/a-2262-0112. Epub 2024 Apr 12.
Madelung's deformity is a congenital or acquired growth disorder of the forearm that can lead to significant impairments in the quality of life of affected patients. Various surgical treatment options for the condition have been described in the literature. This study aimed to investigate whether physiolysis with resection of the Vickers ligament can successfully halt the progression of the disease in a cohort of young patients, as would be expected based on existing literature on this topic.
An analysis was performed on the records of all patients with Madelung's deformity who were primarily treated with physiolysis with resection of the Vickers ligament between January 2001 and June 2017. Patients were invited for follow-up examinations, and surgical outcome was assessed. Parameters evaluated included pain at rest and under load, range of motion of the wrists, and activity level. Additionally, standard X-rays and radiological measurements were performed for each operated wrist. The collected data was compared with the preoperative data from patient records.
Nine wrists were included in the study. The average age at the time of surgery was 13.2 years, and the average follow-up period was five years. Extension and ulnar abduction showed a slight decrease from preoperative to follow-up, while flexion improved minimally, and radial abduction and forearm rotation showed noticeable improvement. The visual analogue scale score for pain at rest increased from preoperative 0.25 points to 1.88 points at follow-up. Under load, the average pain score increased from 2.00 to 4.25 points. The mean DASH score increased from 6.04 points before the surgical procedure to 12.20 points at follow-up. The average values of two out of the five measured McCarroll parameters increased, the increase being statistically significant for lunate subsidence. A follow-up procedure was required in one wrist.
In our cohort, the progression of Madelung's deformity was only partially halted by physiolysis with resection of the Vickers ligament, and a significant increase in pain symptoms during the study period could not be avoided. Therefore, this procedure should be used cautiously in skeletally immature patients.
马德隆畸形是一种先天性或后天性的前臂生长紊乱疾病，可导致受影响患者的生活质量严重受损。文献中已描述了针对该病症的各种手术治疗方案。本研究旨在调查，基于关于该主题的现有文献，切除维氏韧带的物理松解术能否成功阻止一组年轻患者的疾病进展。
对2001年1月至2017年6月期间主要接受切除维氏韧带物理松解术治疗的所有马德隆畸形患者的记录进行分析。邀请患者进行随访检查，并评估手术结果。评估的参数包括静息和负重时的疼痛、手腕活动范围以及活动水平。此外，对每只接受手术的手腕进行标准X线检查和放射学测量。将收集的数据与患者记录中的术前数据进行比较。
本研究纳入了9只手腕。手术时的平均年龄为13.2岁，平均随访期为5年。从术前到随访，伸展和尺侧外展略有下降，而屈曲略有改善，桡侧外展和前臂旋转有明显改善。静息时疼痛的视觉模拟量表评分从术前的0.25分增加到随访时的1.88分。负重时，平均疼痛评分从2.00分增加到4.25分。平均DASH评分从手术前的6.04分增加到随访时的12.20分。五个测量的麦卡罗尔参数中有两个的平均值增加，其中月骨下沉的增加具有统计学意义。一只手腕需要进行后续手术。
在我们的队列中，切除维氏韧带的物理松解术仅部分阻止了马德隆畸形的进展，且在研究期间无法避免疼痛症状的显著增加。因此，该手术在骨骼未成熟的患者中应谨慎使用。
