Department of Surgical Oncology, Marengo CIMS Cancer Centre, Ahmedabad, India.
Department of Surgical Oncology, BALCO Medical Centre, Raipur, India.
Bone Joint J. 2024 Nov 1;106-B(11):1301-1305. doi: 10.1302/0301-620X.106B11.BJJ-2024-0337.R1.
Reconstruction after osteoarticular resection of the proximal ulna for tumours is technically difficult and little has been written about the options that are available. We report a series of four patients who underwent radial neck to humeral trochlea transposition arthroplasty following proximal ulnar osteoarticular resection.
Between July 2020 and July 2022, four patients with primary bone tumours of the ulna underwent radial neck to humeral trochlea transposition arthroplasty. Their mean age was 28 years (12 to 41). The functional outcome was assessed using the range of motion (ROM) of the elbow, rotation of the forearm and stability of the elbow, the Musculoskeletal Tumor Society score (MSTS), and the nine-item abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH-9) score.
All patients were available for follow-up at a mean of 33 months (25 to 43) and were disease-free. The mean flexion arc was 0° to 105°. Three patients had complications. One had neuropraxia of the ulnar nerve. The symptoms resolved after three months. In one patient, the screw used for fixation of the triceps tendon became exposed and was removed, six months postoperatively. One patient with wound dehiscence required a local flap for soft-tissue cover, four months postoperatively. At a mean follow-up of 33 months (25 to 43), the mean flexion arc was 0° to 105°. All patients had full supination (85°) but none had any pronation. The mean MSTS score was 23.5 (23 to 24) and mean QuickDASH-9 score was 26.13 (16.5 to 35.75). Three patients had varus-valgus instability on examination, although only one had a sense of instability while working.
Radial neck to humeral trochlea transposition offers a satisfactory and cost-effective biological reconstructive option after osteoarticular resection of the proximal ulna, in the short term. It provides good elbow function and, being a biological reconstruction option using native bone, is likely to provide long-term stability and durability.
尺骨近段骨关节切除后进行重建技术难度大，可供选择的方法鲜有报道。我们报告了 4 例尺骨近段骨关节切除后行桡骨颈至肱骨干滑车转移关节成形术的患者。
2020 年 7 月至 2022 年 7 月，4 例尺骨原发性骨肿瘤患者接受桡骨颈至肱骨干滑车转移关节成形术。平均年龄 28 岁（12-41 岁）。采用肘关节活动度（ROM）、前臂旋转度和稳定性、肌肉骨骼肿瘤学会评分（MSTS）和九项简化版上肢残疾问卷（QuickDASH-9）评分评估功能结果。
所有患者平均随访 33 个月（25-43 个月），均无疾病。平均屈曲弧为 0°-105°。3 例患者出现并发症。1 例尺神经神经卡压。术后 3 个月症状缓解。1 例用于固定三头肌腱的螺钉暴露并在术后 6 个月取出。1 例患者术后 4 个月发生伤口裂开，需局部皮瓣覆盖软组织。平均随访 33 个月（25-43 个月）时，平均屈曲弧为 0°-105°。所有患者均完全旋后（85°），但均无旋前。平均 MSTS 评分为 23.5（23-24），平均 QuickDASH-9 评分为 26.13（16.5-35.75）。3 例患者检查时存在内翻-外翻不稳定，但仅 1 例患者在工作时感觉不稳定。
桡骨颈至肱骨干滑车转移在尺骨近段骨关节切除后提供了一种满意且具有成本效益的生物重建选择，短期效果良好。它提供了良好的肘关节功能，并且作为一种使用原生骨的生物重建选择，可能具有长期的稳定性和耐久性。
