Cleary J E, Omer G E
J Bone Joint Surg Am. 1985 Apr;67(4):539-45.
We evaluated the cases of twenty-three patients with thirty-six congenital proximal radio-ulnar synostoses who had been followed between 1938 and 1984. None of the patients had had any attempt at surgical correction or any ipsilateral congenital anomalies. Emphasis was placed on analyzing the natural history of the lesion in these patients who had not been operated on, and on determining the effect of a fixed position of the forearm on function. Ten patients had unilateral and thirteen, bilateral synostosis. Their mean age when last examined was twenty-two years (range, three to fifty years). Eight patients were female and fifteen, male. The forearms were fixed in an average of 30 degrees of pronation. The position of the forearm was not found to be related to subjective functional limitations, employment status, or the results of the hand-function test of Jebsen et al. Most patients had few or no functional limitations, and were employed in jobs that demanded extensive use of the forearm. Contrary to the findings of other studies, we observed four distinct radiographic patterns based on the presence of an osseous synostosis and the position of the radial head. However, we noted no relationship between any of these patterns and function. We concluded that operative treatment of congenital radio-ulnar synostosis is rarely indicated, that less emphasis should be placed on the single factor of the position of the forearm, and that objective functional tests should be included in the assessment of these patients.
我们评估了1938年至1984年间随访的23例患有36处先天性近端桡尺关节融合症的患者病例。所有患者均未尝试过手术矫正，也没有任何同侧先天性异常。重点在于分析这些未经手术治疗的患者中病变的自然病程，以及确定前臂固定位置对功能的影响。10例患者为单侧融合，13例为双侧融合。他们最后一次接受检查时的平均年龄为22岁（范围为3至50岁）。8例为女性，15例为男性。前臂平均固定在旋前30度的位置。未发现前臂的位置与主观功能受限、就业状况或Jebsen等人的手功能测试结果有关。大多数患者几乎没有或没有功能受限，并且从事需要大量使用前臂的工作。与其他研究结果相反，根据骨融合的存在情况和桡骨头的位置，我们观察到四种不同的影像学模式。然而，我们注意到这些模式中的任何一种与功能之间均无关联。我们得出结论，先天性桡尺关节融合症很少需要手术治疗，应减少对前臂位置这一单一因素的重视，并且在对这些患者的评估中应纳入客观功能测试。
