Miyashima Yusuke, Uemura Takuya, Okada Mitsuhiro, Saito Kosuke, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzakicho, Abeno-ku, Osaka 545-0053, Japan.
J Orthop Sci. 2025 Sep;30(5):798-804. doi: 10.1016/j.jos.2024.11.007. Epub 2024 Dec 9.
Ulnar shortening osteotomy (USO) is a well-established surgical technique for ulnar impaction syndrome and triangular fibrocartilage complex injuries, but complications like delayed union and nonunion are often encountered. Transverse and oblique osteotomy techniques are commonly used, yet direct comparisons using advanced implants are limited. This study aims to compare the clinical and radiological outcomes of USO using the Jplate with a transverse osteotomy device and the APTUS Wrist Ulna Shortening System 2.5 with an oblique osteotomy device.
We retrospectively reviewed 37 patients who underwent USO (15 and 22 treated with the Jplate and APTUS systems, respectively) from July 2009 to October 2022. Clinical outcomes were measured using the visual analog scale (VAS), grip strength, range of motion, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and Hand20 scores. Radiological outcomes included time to bone union, delayed union, and nonunion rates. Statistical analyses involved Mann-Whitney and Kruskal-Wallis tests and multivariable linear regression models adjusted for age, sex, and smoking status.
Time to union was faster in the APTUS group compared to the Jplate group, with a significantly higher delayed union rate in the Jplate group than in the APTUS group. Postoperative pain reduction was significantly greater in the APTUS group compared to the Jplate group. Improvements in Hand20 scores were also significantly higher in the APTUS group compared to the Jplate group. Multivariable regression analyses confirmed that the APTUS system significantly shortened time to union and improved VAS and Hand20 scores.
The APTUS system provides superior clinical and radiological outcomes compared to the Jplate, with significant reductions in delayed union rates and postoperative pain and earlier bone healing. This system enables oblique osteotomy and compression of the osteotomy site with a single device, which may have contributed to the observed differences in our study.
Level 4.
尺骨短缩截骨术（USO）是治疗尺骨撞击综合征和三角纤维软骨复合体损伤的一种成熟的手术技术，但常出现延迟愈合和不愈合等并发症。常用的截骨技术有横行和斜行截骨术，然而使用先进植入物的直接比较有限。本研究旨在比较使用Jplate（一种横行截骨装置）和APTUS腕尺骨短缩系统2.5（一种斜行截骨装置）进行尺骨短缩截骨术的临床和影像学结果。
我们回顾性分析了2009年7月至2022年10月期间接受尺骨短缩截骨术的37例患者（分别使用Jplate和APTUS系统治疗15例和22例）。使用视觉模拟量表（VAS）、握力、活动范围、手臂、肩部和手部快速残疾问卷以及Hand20评分来评估临床结果。影像学结果包括骨愈合时间、延迟愈合率和不愈合率。统计分析采用Mann-Whitney检验、Kruskal-Wallis检验以及针对年龄、性别和吸烟状况进行调整的多变量线性回归模型。
与Jplate组相比，APTUS组的愈合时间更快，Jplate组的延迟愈合率显著高于APTUS组。与Jplate组相比，APTUS组术后疼痛减轻更为显著。与Jplate组相比，APTUS组的Hand20评分改善也更为显著。多变量回归分析证实，APTUS系统显著缩短了愈合时间，并改善了VAS和Hand20评分。
与Jplate相比，APTUS系统具有更好的临床和影像学结果，延迟愈合率和术后疼痛显著降低，骨愈合更早。该系统可使用单个装置进行斜行截骨和截骨部位的加压，这可能是我们研究中观察到差异的原因。
4级。
