手术治疗先天性尺桡骨融合9例临床研究

目的:探讨先天性尺桡骨融合前臂极度旋前,不能旋后的手术治疗效果。方法:对1994年3月～2004年3月我院收治的9例先天性尺桡骨融合患者,进行桡骨远端截骨术联合尺骨近端截骨术,术后随访36个月,观察患者前臂旋转状况。结果:术前9例患者前臂均极度旋前85°,不能旋后,术后36个月后,患者3例前臂旋前5°旋后5°,6例旋前5°,旋后15°,术前及术后随访患者前臂旋后功能有统计学差异(P<0.01)。结论:先天性尺桡骨融合患者行桡骨远端截骨联合尺骨近端截骨术可以改善患者前臂的旋后功能,术后无并发症,疗效显著。     

融合部旋转短缩截骨治疗儿童先天性上尺桡骨融合

目的 探讨融合部旋转短缩截骨治疗儿童先天性上尺桡骨融合的疗效.方法 回顾性分析采用融合部旋转短缩截骨治疗的儿童先天性上尺桡骨融合13例(14侧肢体),男10例、女3例;年龄2～7岁,平均3.5岁.前臂旋前畸形50°～90°,平均82.1°.患侧手不能完成端碗进食、护理个人卫生、转动球形门把手、开锁、伸手接物等日常动作,手臂外观异常.均行融合部旋转短缩截骨治疗,取肘后Boyd切口,松解尺桡骨近端骨间膜,融合部截骨短缩0.5 cm,旋转前臂至中立位或旋后10°～20°位对合截骨端,以克氏针固定.8～16周截骨端骨性愈合后取出内固定.结果 融合部旋转短缩截骨后前臂固定于中立位或旋后10°～20°位,前臂旋前畸形平均矫正90.7°.未出现前臂缺血性挛缩及切口感染,截骨处愈合顺利.术后患肢外观改善,患儿可完成端碗进食、护理个人卫生等日常动作,生活质量改善,家属和患儿对手术效果满意.全部患者获得随访,随访时间14～88个月,矫正角度无丢失.结论 融合部旋转短缩截骨治疗先天性上尺桡骨融合能够改善外观和患肢功能,术后肢体发生缺血挛缩的风险低.     

倒凹形旋转截骨术治疗先天性尺桡骨近端联结

先天性尺桡骨近端骨性联结(congenital radioulnar synostosia)是一种少见的先天性畸形，主要是尺骨和桡骨近端发生骨性联结，使前臂固定在不同角度的旋前位。尺桡骨近端截骨术是目前公认的较好的治疗方法之一，自1987年以来，在传统截骨方法的基础上加以改良，采用倒凹形旋转截骨术治疗先天性尺桡骨近端骨性联结9例，效果良好，现报告如下。     

先天性尺桡骨近端骨折融合3例

1病例资料例 1,男,6岁。左侧受累。前臂主动旋前0°-15°,旋后0°受限,右前臂运动功能正常。双上肢在生活、玩耍中无明显困难。X线片示：右尺桡骨正常,左尺桡骨未见骨性融合,但有桡骨头脱位,按Tachdjian分型为Ⅲ型。     

桡骨粗隆下截骨术治疗先天性上尺桡关节融合

[目的]研究先天性上尺桡关节融合的治疗方法及疗效。[方法]10例行单侧桡骨粗隆下截骨，术后辅以功能锻炼。[结果]1例因功能锻炼困难，旋后功能不满意，其余9例均获满意的功能。[结论]桡骨粗隆下截骨术辅以较完善的功能锻炼是治疗先天性上尺桡关节融合一个较好的方法。     

尺骨短缩术治疗桡骨骨折后尺骨撞击综合征

目的 评价尺骨短缩术治疗尺骨撞击综合征的效果及其影响因素. 方法 2002年1月至2006年12月对28例诊断为腕部尺骨撞击综合征患者给予尺骨截骨短缩治疗,采用改良的Gartland and Werley腕关节功能评分系统判定治疗效果;分析尺骨短缩数量与手术效果的关系. 结果 本组术前尺骨阳性变异23例,中件变异3例,阴性变异2例;术后阳性变异3例,中性变异4例,阴性变异21例.尺骨变异术前平均(3.1±2.3)mm,术后平均(0.9±1.4)mm,差异有统计学意义(t=4.32,P<0.05).按改良的Gartland and Werley评分:术前平均为(62.6±4.3)分,可21例,差7例;术后评分改善到平均为(92.2±7.8)分,优22例,良3例,可2例,差1例,腕关节功能评分术前与术后比较差异有统计学意义(t=10.45,P<0.05).3例切断尺桡远端韧带,4例部分切断尺桡远端韧带.6例术前存在远端尺腕部背侧半脱位,尺骨短缩术后明显改善. 结论 尺骨短缩术能显著改善桡骨远端骨折后继发尺骨撞击综合征的功能评分和临床症状;但尺骨短缩过多,远侧尺桡关节间压力增大,则影响手术效果.     

超薄钢片置入治疗创伤性尺桡骨融合

目的：置入超薄钢片，防止尺桡骨间骨桥再次形成，改善患者前臂旋转功能。方法：本组共５例创伤后尺桡骨骨性融合病例，切除骨桥后将超薄钢片置入尺桡骨间，防止再次发生尺桡骨融合，以改善患者前臂旋转功能。结果：本组患者随访时间为１８个月～４年，取得了良好效果。前臂旋转功能得到改善：旋前角度改善２５°～４０°，平均３０°；旋后角度改善３０°～６０°，平均４０°。超薄钢片在体内未发现有不良反应。结论：在切除骨桥位置置入超薄钢片，防止了骨桥再次形成，前臂旋转功能得到了改善。超薄钢片在人体内生物相容性好，无不良反应。     

尺桡骨髓内钉治疗尺桡骨骨折的临床观察

自2004年6月～2006年1月,笔者采用闭合复位或小切口复位下的尺桡骨髓内钉内固定治疗尺桡骨骨干骨折20例,获随访的16例,治疗效果理想,现报告如下.     

Surgical correction of deformities of the distal radius due to fractures in pediatric patients

Introduction The indication and treatment of malunited fractures of the distal radius in the growing skeleton differ from those for adults. The literature results are scarce. In this study we examined the results of surgical correction following fractures of the distal radius in infants.Materials and methods Seven infant patients with malaligned fractures of the distal radius that demonstrated significant functional deficit and poor prognosis for spontanous recovery were treated with surgical correction. Two of them were treated because of growth disturbance from post-traumatic closure of the distal radial physis.Results All seven osteotomies healed with acceptable radiologic alignment. After an average follow-up period of 3 years and 1 month (range 10 months to 8 years and 4 months), patients had an average range of wrist motion (ROM) of 131 deg in extension and flexion (93% of the contralateral side, 130% of presurgical situation); 65 deg in ulnar and radial deviation (94% of the contralateral side, 122% of presurgical situation); and 177 deg in pronation and supination of the forearm (97% of the contralateral side, 115% of presurgical situation). The average grip strength of 71.4 kPa was nearly equal to the other side with 72.8 kPa. The average postoperative angulation of the distal radius was 12 (range 10–17) deg, the radial inclination 20 (range 12–30) deg, and the ulnar variance was –0.6 (range –3 to +2) mm. According to the Fernandez point score system as well as the scale of Fernandez, there were five excellent results and two good results. The patients described low disability on the DASH scores, with a median of 4 (range 0–41) points.Conclusions Surgical correction for malunited fractures of the distal radius provides good and excellent radiological and functional results in the growing skeleton. It should be considered immediately if there is poor remodeling capacity and disabling loss of function.     

应用保留桡骨头桡骨颈节段性截骨治疗创伤后上尺桡关节骨性融合的早期疗效

目的探讨保留桡骨头的桡骨颈节段性截骨治疗创伤后上尺桡关节骨性融合的早期疗效。方法回顾分析2017年1月至2019年5月广州医科大学附属第二医院创伤骨科采用保留桡骨头的桡骨颈节段性截骨术治疗的创伤性上尺桡关节骨性融合患者7例的临床资料。其中男5例,女2例;年龄为(35±11)岁(19~60岁)。患肢均为右侧。评价术前与随访时患肢前臂旋转活动度、肘和腕关节疼痛程度、握力以及尺骨变异程度和截骨处异位骨化情况并进行比较。采用SPSS 18.0软件对数据进行处理。结果随访(4±0.4)个月(2~6个月)。术前与术后3个月前臂旋转活动度分别为(43±14)°(15°~51°)和(120±31)°(111°~134°),差异有统计学意义(P=0.012);握力分别为(25.5±10.3)kg(21.2~28.6 kg)和(26.3±11.1)kg(21.7~28.4 kg),差异无统计学意义(P=0.074);尺骨变异分别为(-0.13±0.04)mm(-0.15^-0.07 mm)和(-0.12±0.09)mm(-0.14^-0.08 mm),差异无统计学意义(P=0.081)。所有患者术前与术后肘关节与腕关节未见疼痛,术后未见截骨处异位骨化形成。结论应用保留桡骨头的桡骨颈节段性截骨治疗创伤后上尺桡关节骨性融合,方法简单,早期疗效令人满意。     

Surgical treatment of posttraumatic radioulnar synostosis in children

The authors describe two children who underwent surgical treatment of radioulnar synostosis. One case involved simple excision; the other, excision and interposition of Gore-Tex vascular graft material. In a review of the literature, no other report of the latter type of surgical treatment was found. A discussion of the literature concerning this rare complication in children and the current surgical treatment options are included.     

先天性上尺桡骨融合畸形患者的远期手术疗效分析

目的介绍先天性上尺桡关节融合畸形手术治疗的效果。方法按Ｋｉｅｎｂｏｃｋ标准分为两型，Ⅰ型为骨性联合，按桡骨小头的形态又可分为有头型和无头型两个亚型；Ⅱ型为软骨或纤维性联合。对５例（４～６岁）１０侧先天性上尺桡关节融合，采用尺骨近端截骨和／桡骨近端切除，尺桡骨联合部截骨术。结果术后随访２～７年，虽无后遗症发生，但所有肘关节伸直及前臂旋转功能改善不明显。结论目前常用的尺骨近端截骨和／或桡骨近端切除，疗效不明显     

Rotational osteotomies for congenital radioulnar synostosis

In five children, six forearms with a fixed pronation deformity secondary to congenital radioulnar synostosis were treated by a derotation osteotomy of the distal radius and the midshaft of the ulna.There were three boys and two girls with a mean age of 4.9 years (3.5 to 8.25) who were followed up for a mean of 29 months (18 to 43). The position of the forearm was improved from a mean pronation deformity of 68 degrees (40 degrees to 80 degrees ) to a pre-planned position of 10 degrees of supination in all cases. Bony union was achieved by 6.3 weeks with no loss of correction. There was one major complication involving a distal radial osteotomy which required exploration for a possible compartment syndrome.     

远端桡尺关节半脱位的CT检查

目的探讨通过 CT检查提高对远端桡尺关节半脱位的诊断率。方法对 56例经 X线检查可疑为远端桡尺关节半脱位的患者（男 36例,女 20例）行双侧远端桡尺关节旋前、旋后位 CT横断扫描。应用 Nakamura的改良桡尺线方法进行测量,经过双侧对比确定尺骨头掌侧或背侧半脱位。结果在 56例 X线检查拟诊为远端桡尺关节半脱位的患者中,尺骨头掌侧半脱位 10例;尺骨头背侧半脱位 15例;另有 2例为尺骨头背侧半脱位,经与健侧对比确定为假阳性。结论通过 CT检查诊断远端桡尺关节半脱位,可减少 X线检查由于难以达到标准投照位置所产生的假阳性,从而提高对远端桡尺关节半脱位的诊断率。对曾有腕关节外伤史或逐渐加重的腕部疼痛及远端桡尺关节活动受限者, CT检查是诊断远端桡尺关节半脱位较为有效的方法。