尺骨斜行短缩截骨术治疗尺骨撞击综合征

目的 探讨尺骨斜行短缩截骨术治疗尺骨撞击综合征的临床疗效与术中操作体会.方法 回顾性分析自2012-03-2018-05诊治的17例(23腕)尺骨撞击综合征,行尺骨斜行短缩截骨术,矫正尺骨正向变异,垂直截骨面予以拉力螺钉加压固定,辅以3.5 mm重建接骨板固定截骨端.术后采用疼痛VAS评分评价腕关节疼痛缓解情况,采用改...     

尺骨截骨并弹性悬吊固定术治疗尺骨撞击综合征

目的探讨尺骨截骨并弹性悬吊固定术治疗尺骨过长造成的尺骨撞击综合征疗效。方法 2015年10月—2016年8月,收治3例尺骨撞击综合征患者。男1例,女2例;年龄分别为32、29、59岁。1例为开放性尺桡骨骨折内固定术后1年余遗留远端尺桡关节脱位并撞击;余2例无明显外伤和手术史,但有长期腕关节劳动史。疼痛视觉模拟评分(VAS)分别为7、5、5分。Cooney腕关节功能评分均为差。术前X线片测量尺骨正向变异分别为12.7、9.0、8.7 mm。在尺骨横形截骨术并钢板螺钉内固定基础上,采用微型钢板弹性悬吊固定远端尺桡关节。结果术后X线片显示患肢远端尺桡关节匹配,与健侧相比无明显差异。患者切口均Ⅰ期愈合,无神经血管损伤、感染及远端尺桡关节脱位等并发症发生。3例患者均获随访,随访时间分别为27、17、23个月。末次随访时X线片示截骨段均骨性愈合,内固定物在位;VAS评分分别为2、0、1分,Cooney腕关节功能评分分别为80、100、90分,均为优。结论尺骨截骨并弹性悬吊固定术可以在纠正尺骨变异的同时,避免尺骨头周围组织广泛剥离造成的远端尺桡关节不稳,也避免刚性固定可能造成的关节僵硬,从而更好地治疗尺骨撞击综合征。     

腕关节镜辅助尺骨短缩截骨术治疗尺骨撞击综合征21例临床分析

目的分析腕关节镜辅助尺骨短缩截骨术治疗尺骨撞击综合征的效果。方法选取2016-01—2018-01间郑州市骨科医院收治的21例尺骨撞击综合征患者,均采用腕关节镜辅助尺骨短缩截骨术。术后随访6～24个月,评价腕关节功能、疼痛缓解效果及截骨愈合情况。结果末次随访,截骨全部愈合良好,平均愈合时间10周。腕关节疼痛明显缓解,腕关节功能优11例、良8例、可2例。结论腕关节镜辅助尺骨短缩截骨术治疗尺骨撞击综合征,可有效改善腕关节疼痛及腕关节功能,促进截骨愈合。     

腕关节镜技术结合尺骨斜形截骨术治疗尺骨撞击综合征

目的 观察腕关节镜技术结合尺骨斜形截骨术治疗尺骨撞击综合征的临床疗效.方法 回顾性分析自2018年1月至2019年12月采用腕关节镜技术结合尺骨斜形截骨术治疗的尺骨撞击综合征患者24例,其中男9例,女15例;年龄21～74岁,平均(44.5±10.1)岁.先采用尺骨斜形截骨钢板内固定术,随后采用腕关节镜对三角纤维软骨复...     

镜下Wafer术与尺骨截骨治疗尺骨撞击综合征

[目的]比较腕关节镜下Wafer术与开放尺骨截骨治疗尺骨撞击综合征的临床疗效。[方法] 2015年12月～2018年12月收治尺骨撞击综合征患者42例,随机分为两组。镜下组19例,行腕关节镜下清理+Wafer术;开放组23例,行开放尺骨干中远1/3斜形截骨。比较两组临床与影像结果。[结果]两组患者均顺利完成手术,镜下组手术时间显著长于开放组,镜下组术中出血量显著少于开放组(P0.05)。两组患者随访12～16个月,平均(14.61±2.19)个月。镜下组患腕开始活动时间、完全负重时间均显著早于开放组(P0.05)。随时间推移,两组患者VAS评分均显著减少(P0.05),而握力、ROM和改良Mayo评分均显著增加(P0.05)。术前及术后6个月,两组间上述指标差异无统计学意义(P0.05),但术后3个月时,镜下组显著优于开放组(P0.05)。影像方面,术前两组患者尺骨阳性变异量差异无统计学意义(P0.05);术后两组患者的尺骨阳性变异均较术前显著减少(P0.05);术后镜下组缩短幅度显著小于开放组(P0.05)。术后两组患者的尺腕角均较术前显著减少(P0.05);相应时间点,两组间尺腕角的差异均无统计学意义(P0.05)。[结论]腕关节镜下清理联合Wafer术对尺骨阳性变异量的矫正小于尺骨截骨术,但两种术式均能显著改善患者术后临床症状和腕关节功能。     

尺骨短缩截骨治疗特发性尺骨撞击综合征的疗效分析

目的 探讨尺骨短缩截骨术治疗特发性尺骨撞击综合征的临床疗效.方法 对2006年8月至2010年6月间收治的11例尺骨撞击综合征患者(均为单侧病变),采用尺骨横形短缩截骨术治疗.术后随访时间平均为32个月,通过比较其术前术后的尺骨变异值、活动度、握力、视觉模拟评分法(visual analog scale,VAS)以及改良的Mayo腕关节评分和DASH评分六项指标,对该术式临床效果进行评价.结果 11例截骨部位均获得骨性愈合.尺骨变异值由术前(2.9±1.3) mm改变为术后(-0.2±0.9) mm.术后腕关节活动度有一定改善,与健侧比较,屈伸活动范围术前(84.9±23.2)％,术后(90.3±13.3)％;旋转活动范围术前(92.2±11.1)％,术后(94.2±9.9)％;尺桡偏范围术前(71.9±11.8)％,术后(81.8±22.7)％.患手占健侧的握力术前(79.7±20.0)％,术后(93.6±8.6)％.VAS疼痛分值术前(7.3±0.7),术后(2.9±1.4).改良的Mayo腕关节评分术前(59.0±19.0),术后(84.0±21.0),其中优5例,良4例,可2例.DASH得分术前(55.0±20.0),术后(25.0±19.0),其中以反映力量型功能和生活信心的项目改进尤为显著.结论 尺骨横形短缩截骨术能够有效改善特发性尺骨撞击综合征患者的腕关节功能,明显减轻疼痛,提高握力,改善生活质量,对腕关节活动范围改善程度有限.     

腕关节镜辅助下截骨治疗尺骨撞击综合征合并TFCC Ⅱ型损伤

目的 探讨腕关节镜辅助下截骨治疗尺骨撞击综合征合并TFCCⅡ型损伤的临床疗效。方法2015年4月-2019年11月对14例尺骨撞击综合征患者,采用腕关节镜下TFCC清创,结合尺骨斜形截骨短缩内固定治疗。结果 术后14例均获得随访,时间为6～24个月,平均10个月,采用Cooney腕关节功能评分系统判定治疗效果：优7例,良5例,可2例。所有患者腕关节疼痛较术前有缓解,疼痛视觉模拟评分(VAS)由术前平均6.5分下降至术后1分。结论 采用腕关节镜辅助下截骨治疗尺骨撞击综合征合并TFCCⅡ型损伤,术后可以获得良好的治疗效果。     

影响尺骨短缩截骨术骨折愈合的危险因素

正尺骨短缩截骨术治疗尺骨撞击综合征的效果良好,但常发生骨折愈合延迟或不愈合。作者对325例行尺骨短缩截骨术的尺骨撞击综合征患者进行了回顾性研究,294例患者骨折愈合良好,31例患者出现骨折愈合延迟或不愈合。单因素和多因素分析提示:吸烟、骨矿密度低和腕关节活动范围减小是骨折愈合延迟或不愈合的主要危险因素。故作者建议,使用尺骨短缩截骨术治疗尺骨撞击综合征最好在不吸烟、骨矿密度正常和     

桥接组合系统在尺骨短缩截骨术治疗尺骨撞击综合征中的应用

目的探讨桥接组合系统实现精确截骨缩短治疗尺骨撞击综合征的临床效果。方法回顾性分析2020年1月到2022年3月收治的25例尺骨撞击综合征患者资料, 均采用桥接组合系统行尺骨短缩术(USO)。女14例, 男11例;年龄(43.2 ± 10.1)岁。术前根据患者CT结果规划手术, 制定个性化截骨方案。术中先将桥接组合系统固定于尺骨, 按照术前规划截骨, 通过桥接组合系统加压闭合截骨间隙后锁定螺钉固定。记录截骨愈合时间、并发症、关节活动度及握力指标, 通过疼痛视觉模拟评分(VAS)和腕关节功能Mayo评分评价治疗效果。结果所有患者术后随访时间为(13.5 ± 1.2)个月;所有患者尺骨变异获得矫正, 截骨端愈合, 无成角、旋转等并发症。末次随访时患者的腕关节疼痛VAS评分[2.0(1.0, 2.0)分]较术前[6.0(5.0, 6.5)分]显著下降, 腕关节Mayo评分[(85.4 ± 8.9)分]、握力[(39.4 ± 1.2)kg]、腕关节屈-伸(111.9°± 12.6°)、旋前-旋后(133.2°± 15.7°), 尺-桡偏(35.3°± 2.8°)活动度均较术前[(69.2 ± 1...     

尺骨截骨联合桡尺韧带重建治疗陈旧性下尺桡关节脱位

目的评估尺骨截骨联合桡尺韧带重建治疗陈旧性下尺桡关节脱位的临床疗效。方法 2013年2月至2016年6月,采用尺骨截骨联合桡尺韧带重建治疗陈旧性下尺桡关节脱位患者14例,男9例,女5例;年龄22~67岁,平均44.3岁。采用改良的Gartland and Werley腕关节功能评分系统评价效果,比较术前、术后6个月腕关节功能状况。结果所有患者均获随访,随访时间3~24个月,平均12.2个月。14例患者按改良的Gartland and Werley腕关节功能评分标准评价,优6例,良5例,可2例,差1例。术后6个月较术前腕关节伸屈、前臂旋转、握力、桡偏、尺偏明显改善(P0.05)。结论尺骨截骨联合桡尺韧带重建能够有效减轻尺骨增长引起的撞击痛,维持前臂的旋转功能,增加握力,是治疗陈旧性下尺桡关节脱位的一种有效的手术方法。     

MSCT图像重建技术在尺骨撞击综合征中的应用

目的评价MSCT图像重建技术在尺骨撞击综合征诊断中的应用价值。方法回顾性分析经腕关节镜检查证实的18例尺骨撞击综合征患者MSCT图像重建技术及标准后前位X线平片检查的影像资料,对尺骨变异、月骨及三角骨异常变化进行统计学分析。结果⑴MSCT图像重建技术及标准后前位X线平片检查测量出的尺骨变异差异无统计学意义(t=0.3562,P>0.05);⑵MSCT图像重建显示18例尺骨阳性变异15例,占总例数83.3%,其中阳性变异超过2 mm者11例,占总阳性变异的73.3%;中性及阴性变异3例,占总例数16.7%;⑶MSCT重建技术显示月骨和/或三角骨异常变化14例,占总例数77.8%,其中单纯月骨异常变化8例,月骨及三角骨同时异常变化5例,单纯三角骨异常变化1例。标准后前位X线平片能显示月骨和/或三角骨异常变化10例,占总例数55.6%,其中单纯月骨异常变化6例、月骨及三角骨同时异常变化4例,无单纯三角骨异常变化;⑷MSCT图像重建技术测量尺骨阳性伴月骨及三角骨异常变化14例,占总例数77.8%,尺骨阳性变异不伴月骨及三角骨异常变化1例,占总例数5.6%。阳性变异大于2 mm伴月骨及三角骨异常变化11例,占总例数61.1%,月骨及三角骨异常变化例数的78.6%。无尺骨中性及阴性变异伴月骨及三角骨异常变化。结论MSCT图像重建技术及后前位X线平片测量尺骨变异无统计学差异;尺骨撞击综合征发展过程中尺骨阳性变异呈易感因素;尺骨阳性变异大于2 mm时易引起月骨、三角骨异常变化;MSCT图像重建技术可以很好地显示尺骨变异及月骨、三角骨骨质硬化情况。     

Arthroscopic treatment of ulnar impaction syndrome

Ulnar impaction syndrome occurs in the setting of a central traumatic or degenerative defect in the triangular fibrocartilage complex in patients with ulnar positive variance. Chondral and subchondral edema, mechanical impingement of the articular disc, and chondromalacia of the distal ulna, proximal lunate, and proximal triquetrum produce symptoms with activity that do not improve with rest. Decreasing ulnocarpal load-sharing across the wrist with recession of the distal ulna is necessary to relieve symptoms in the majority of patients. Arthroscopic treatment with triangular fibrocartilage complex debridement and arthroscopic ulnar wafer resection is an effective treatment for ulnar impaction syndrome. It affords a single-stage, minimally invasive approach, with similar efficacy and fewer complications than open wafer resection or ulnar shortening osteotomy.     

Carpal impaction with the ulnar styloid process: treatment with partial styloid resection

Carpal impaction with the ulnar styloid process (stylocarpal impaction) occurs less frequently than with the ulnar head (ulnocarpal impaction), and more commonly develops in wrists with negative ulnar variance. Physical examination, radiographic evaluation, and wrist arthroscopy are all helpful in excluding alternative causes of ulnar wrist pain. When an ulnocarpal stress test elicits pain, and radiographs suggest that this is due to carpal impaction with the ulnar styloid, partial resection of the styloid process provides successful treatment, so long as the insertion of the triangular fibrocartilage at the base of the styloid is not disrupted.     

Ulnar impaction

Ulnar impaction syndrome is a common source of ulnar-sided wrist pain. It is a degenerative condition that occurs secondary to excessive load across the ulnocarpal joint, resulting in a spectrum of pathologic changes and symptoms. It may occur in any wrist but is usually associated with positive ulnar variance, whether congenital or acquired. The diagnosis of ulnar impaction syndrome is made by clinical examination and is supported by radiographic studies. Surgery is indicated if nonoperative treatment fails. Although a number of alternatives exist, the 2 primary surgical options are ulnar-shortening osteotomy or partial resection of the distal dome of the ulna (wafer procedure). This article discusses the etiology of ulnar impaction syndrome, and its diagnosis and treatment.     

Oblique ulnar shortening osteotomy with a new plate and compression system

Ulnocarpal abutment or the ulnocarpal impaction syndrome occurs when excessive loads exist between the distal ulna and ulnar carpus. This overloading occurs as a result of the distal ulnar articular surface being more distal than the ulnar articular surface of the distal radius. This situation has been termed positive ulnar variance, and it can quickly lead to ulnar-sided wrist degenerative changes and functional losses. Patients often have vague, ulnar-sided complaints of chronic pain and swelling with an insidious onset that does not correlate with any specific traumatic event. Many procedures have been developed to alleviate this condition, but the gold standard for correcting positive ulnar variance is the ulnar shortening osteotomy. The goals of the shortening procedure are to relieve pain and prevent arthritis by reestablishing a neutral or slightly negative ulnar variance. We describe a new plate and compression system in which an oblique ulnar diaphyseal osteotomy is both completed and stabilized through the same jig-based system.     

Ulnar impaction syndrome: Managed by wrist arthroscopy

Background:

The development of handicraft industry and increase of various such works that need a large amount of repeated wrist ulnar deviation strength, the incidence of ulnar impaction syndrome (UIS) is increasing, but the traditional simple ulnar shortening osteotomy has more complications. This study aimed to explore the early diagnostic criteria of UIS and its wrist arthroscopic treatment experience.

Materials and Methods:

9 UIS patients were enrolled in this study. According to magnetic resonance imaging, X-ray and endoscopic features, the diagnostic criteria of UIS were summarized and the individualized treatment schedule was made. If the ulnar positive variance was less than 4 mm, the arthroscopic wafer resection was performed. If the ulnar positive variance was more than 4 mm, the arthroscopic resection of injury and degenerative triangular fibrocartilage complex and ulnar osteotomy were conducted.

Results:

In all patients, the wound healed without any complications. All patients returned to normal life and work, with no ulnar wrist pain again. One patient had wrist weakness. There was a significant difference of the wrist activity between the last followup and before operation (P < 0.05). According to the modified wrist function scoring system of Green and O’Brien, there were 6 cases of excellent, 2 cases of good and 1 case of appropriate and the overall excellent and good rate was 92.3%.

Conclusion:

In the treatment of UIS, the arthroscopy can improve the diagnosis rate, optimize the treatment plan, shorten the treatment cycle, with good treatment results.     

Results of ulnar shortening osteotomy for ulnocarpal impaction syndrome in wrists with neutral or negative ulnar variance

Ulnocarpal impaction syndrome was diagnosed in six wrists of five patients with neutral or negative ulnar variance. All underwent ulnar shortening with satisfactory results. The average grip strength increased from 53% to 78% and the range of flexion-extension increased from 82% to 93%, the mean Cooney's score improved from 25 to 83. These cases show that ulnocarpal impaction syndrome can occur in wrists with zero or negative ulnar variance, and that ulnar shortening is an effective treatment for such wrists.     

The value of the pronated-grip view radiograph in assessing dynamic ulnar positive variance: a case report

Positive ulnar variance affects surgical decision making when ulnar wrist pain is refractory to conservative treatment and is either secondary to a posttraumatic triangular fibrocartilage tear or associated with ulnar impaction syndrome. In such settings, ulnar recession may be necessary to diminish load transmission across the ulnocarpal joint. We present a case of a 24-year-old man with chronic right ulnar wrist pain that illustrates the efficacy of the pronated-grip radiograph in assessing dynamic ulnar positive variance.     

Ulnocarpal impaction syndrome restricts even midcarpal range of motion.

Ulnocarpal impaction syndrome is believed to be caused by abutment between the ulna and the ulnar carpus. We measured radiocarpal and midcarpal ranges of motion in 40 patients with ulnocarpal impaction syndrome by radiographic motion studies. The results showed that the radiocarpal and midcarpal ranges of motion were equally restricted in the affected wrist compared with the unaffected wrist. Therefore, motion of the radiocarpal joint and midcarpal joint contributed equally to total wrist motion bilaterally. No correlation between ulnar variance and the contribution of radiocarpal motion to overall wrist motion was found. Restriction of wrist motion in ulnocarpal impaction syndrome is not caused directly by abutment between the ulna and ulnar carpus, but a satisfactory explanation for restricted motion is still lacking.