Mesas Aranda Irene, Haas-Lützenberger Elisabeth Maria, Imam Sara, Giunta Riccardo E, Volkmer Elias
Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, 80336 Munich, Germany.
Division of Vascular Surgery, Helios Klinikum Munich West, 81241 Munich, Germany.
J Clin Med. 2024 Jul 7;13(13):3972. doi: 10.3390/jcm13133972.
: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. : Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education.
尺骨撞击综合征（UIS）是一种常见的腕关节退行性疾病，由尺骨正向变异引起，导致尺侧腕骨负荷过重。如果保守治疗失败，尺骨短缩截骨术（USO）和关节镜下垫片手术（AWP）是治疗UIS的既定疗法。本研究评估了一种算法引导下的UIS治疗方法，为期10年。这项前瞻性观察性研究根据预定义的治疗算法，比较了54例因UIS接受USO或AWP治疗的患者的治疗结果。平均随访期为10年。主要结局参数为疼痛视觉模拟量表（VAS）和手臂、肩部和手部功能障碍问卷（DASH），次要结局参数为握力、捏力和活动范围。USO组术前尺骨变异中位数为2.6mm，AWP组为2.0mm。两组术后平均尺骨变异均为0mm。USO组术前静息痛为3.4，AWP组为2.3。术后1年，分别显著降至VAS 0.7和0.2。这些结果持续到10年随访期（VAS 0.9和0.2）。活动时疼痛在第1年也显著下降（从6.8和6.7降至2.2和2.1），10年后也是如此（2.4和1.0）。USO组术前DASH评分平均为31.3，AWP组为35.8。在10年随访时，两组DASH评分均显著下降，AWP组为4.35，USO组为12.7。我们的数据表明，当使用我们的算法时，USO和AWP这两种UIS常见的手术治疗选择，在至少10年的时间里，都能可靠地减轻疼痛并显著降低DASH评分。10年后的结果与短期结果不同，因为术后1年时，USO组在某种程度上显示出与AWP组相似的结局参数，而在10年随访时，AWP组的主要结局参数略好。因此，所提出的算法产生了优异的短期和长期结果。我们的研究结果和应用的算法有助于决策制定和患者教育。
