目的 探讨改良尺骨逐步延长法治疗由遗传性多发性骨软骨瘤引发的Masada Ⅰ型前臂畸形的临床效果。方法 收集2014-06至2020-10就诊于首都医科大学附属北京儿童医院骨科,遗传性多发性骨软骨瘤引发的Masada Ⅰ型前臂畸形接受改良尺骨逐步延长法手术患者10例(共11肢),男8例,女2例,手术年龄(10.0±2.8)岁,回顾性分析其临床及影像资料,比较手术前后桡骨关节面角度(RAA),腕骨偏移度(CS),相对尺骨短缩长度 ( RUS)。临床评价腕关节屈曲、伸直活动度,腕关节尺偏、桡偏活动度,前臂旋前、旋后活动度,肘关节屈伸活动范围。结果 10例患者术后平均随访(38.2±6.6)个月,尺骨平均延长距离(38.9±6.6)mm。术前与末次随访的RAA[(40.1°±14.2°)vs.(39.3°±13.8°)]、前臂旋后活动度[(48.2°±7.5°)vs.(53.6°±6.0°)]、肘关节屈伸活动度[(135.5°±3.5°)vs.(136.8°±3.4°)] 无显著统计学差异(P＞0.05);术前与末次随访的CS[(65.0%±22.5%)vs.(34.1%±10.4%)],RUS[(11.2±2.2 )mm vs. (-3.9±5.3)mm]、腕关节屈曲活动度[(40.0°±7.7°)vs. (54.5±7.9°)]、腕关节伸直活动度[(45.9°±8.6°)vs. (61.4°±6.4°)],腕关节尺偏活动度[(42.7°±7.5°)vs.(30.5°±6.5°)]、腕关节桡偏活动度[(17.7°±4.7°)vs.(29.1°±4.9°)],前臂旋前活动度[(59.1°±5.4°)vs. (65.0°±3.9°)]存在统计学差异(P＜0.05)。随访过程中出现病理性骨折1例。结论 改良尺骨逐步延长法能够有效治疗遗传性多发性骨软骨瘤引发的Masada I型前臂畸形,改善前臂功能。
Abstract
Objective To investigate the clinical effect of modified gradual ulnar lengthening in the treatment of Masada type I forearm deformity caused by hereditary multiple osteochondroma. Methods A total of 10 (11 limbs) patients with Masada type I forearm deformity caused by hereditary multiple osteochondroma were treated at the Department of Orthopedics of Beijing Children's Hospital affiliated to Capital Medical University from June 2014 to October 2020. The patients, 8 males and 2 females, were (10.0±2.8) years old. The clinical and imaging data were retrospectively analyzed, and the radial articular articular angle (RAA), carpal slip (CS), relative ulna shortening (RUS) were compared before and after surgery. The flexion and extension range of wrist, the ulnar deviation and radial deviation of wrist, the pronation and supination range of forearm and the flexion and extension range of elbow were evaluated. Results The mean follow-up was (38.2±6.6) months, and the mean length of the ulna was (38.9±6.6) mm. There were no statistically significant differences between preoperative and last follow-up in RAA[(40.1°±14.2°) vs. (39.3°±13.8°)], supination of forearm [(48.2°±7.5°) vs. (53.6°±6.0°)], elbow range of motion [(135.5°±3.5°) vs. (136.8°±3.4°)], (P＞0.05). There were significant differences between post-operative and last follow-up in CS [(65.0%±22.5%) vs. (34.1%±10.4%)], RUS [(11.2±2.2)mm vs. (-3.9±5.3)mm], wrist flexion [(40.0°±7.7°) vs. (54.5°±7.9°)], wrist extension [(45.9°±8.6°) vs. (61.4°±6.4°)], ulnar deviation [(42.7°±7.5°) vs. (30.5°±6.5°)], radial deviation [(17.7°±4.7°) vs. (29.1±4.9°)] and pronation of forearm [(59.1°±5.4°) vs. (65.0°±3.9°)], (P<0.05). Pathological fracture occurred in 1 case during follow-up. Conclusions Modified gradual ulnar lengthening can effectively treat Masada type I forearm deformity caused by hereditary multiple osteochondroma and improve forearm function.
关键词
改良尺骨逐步延长法 /
遗传性多发性骨软骨瘤 /
前臂畸形 /
Masada I型
Key words
modified gradual ulnar lengthening /
hereditary multiple osteochondroma /
forearm deformity /
Masada type Ⅰ
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