Kanaya F, Ibaraki K
Department of Orthopedic Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan.
J Bone Joint Surg Am. 1998 Aug;80(8):1186-92. doi: 10.2106/00004623-199808000-00012.
We present the results of a new mobilization procedure for the treatment of a congenital proximal radioulnar synostosis in seven patients. The operative procedure included separation of the synostosis and placement of a free vascularized fascio-fat graft to prevent recurrent ankylosis. The average age at the time of the operation was eight years and two months (range, six years and four months to eleven years and ten months). All of the patients were boys who had no other congenital anomalies. The radial head was dislocated in all seven patients (anteriorly in two and posteriorly in five). The final four index operations included an osteotomy of the radius in order to reduce the dislocated radial head. The average duration of follow-up was three years and eight months (range, two years and four months to four years and five months). Preoperatively, the patients had had difficulty with holding a bowl of soup and accepting objects, such as coins, into the palm. Postoperatively, they were able to perform these activities. None of the patients had recurrent ankylosis or loss of the flap. The average supination was 26 degrees (range, 10 to 45 degrees), and the average pronation was 45 degrees (range, 10 to 80 degrees). The four patients who had had an osteotomy of the radius in addition to the index procedure did not have a dislocation of the radial head and had an average arc of motion of 83 degrees of pronation and supination. The three patients who had not had an osteotomy had a dislocation of the radial head and an average arc of motion of 40 degrees after the index procedure. These findings demonstrate that separation of a congenital radioulnar synostosis with a vascularized fascio-fat graft and osteotomy of the radius can achieve pronation and supination of the forearm.
我们展示了一种用于治疗7例先天性近端桡尺关节融合的新动员程序的结果。手术程序包括分离关节融合并植入游离带血管筋膜脂肪移植以防止再次强直。手术时的平均年龄为8岁2个月（范围为6岁4个月至11岁10个月）。所有患者均为男孩，无其他先天性异常。7例患者的桡骨头均脱位（2例向前，5例向后）。最后的4例主要手术包括桡骨截骨术以复位脱位的桡骨头。平均随访时间为3年8个月（范围为2年4个月至4年5个月）。术前，患者难以端一碗汤以及将硬币等物品放入手掌。术后，他们能够进行这些活动。所有患者均未出现再次强直或皮瓣丢失。平均旋后为26度（范围为10至45度），平均旋前为45度（范围为10至80度）。除主要手术外还进行了桡骨截骨术的4例患者没有桡骨头脱位，旋前和旋后的平均活动弧度为83度。未进行截骨术的3例患者出现桡骨头脱位，主要手术后平均活动弧度为40度。这些发现表明，采用带血管筋膜脂肪移植分离先天性桡尺关节融合并进行桡骨截骨术可实现前臂的旋前和旋后。
