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Abstract：
OBJECTIVE: Approximately 30% of patients with hereditary multiple osteochondromas (HMO) have forearm deformity and dysfunction. The aim of this retrospective study was to review our experience with the surgical treatment of children with HMO and Masada IIb forearm deformities.
METHODS: Data of eight children treated for HMO Masada IIb forearm deformity at our hospital between 2015 and 2019 were collected from the hospital records and retrospectively reviewed. All patients underwent ulnar lengthening by distraction osteogenesis using either the Orthofix or Ilizarov external fixator. Range of movements at the elbow and wrist joints, and forearm supination/pronation, before and after the operation were recorded. Radiographs were evaluated by the Fogel method, and wrist joint function by the Krimmer method.
RESULTS: Follow-up radiographs showed significant improvement in relative ulnar shortening after treatment (pre-operative 9.23 ± 5.21 mm; post-operative 0.33 ± 4.13 mm). Changes in radial articular angle (pre-operative 33.55° ± 3.88° to 32.78° ± 6.57°) and carpal slip (pre-operative 45.00% ± 19.09%; post-operative 43.13% ± 16.68%) were not significant. Elbow flexion and extension, wrist flexion and extension, ulnar and radial deviation at wrist, and forearm rotation were significantly improved after surgery. Wrist function was graded as excellent in seven patients and as good in one patient. One patient treated with the Ilizarov external fixator had poor radial head reduction.
CONCLUSIONS: Ulnar lengthening with distraction osteogenesis is an effective treatment for HMO Masada IIb deformities. The optimum site for ulnar osteotomy appears to be at the proximal one-third to one-fourth of the ulna.
METHODS: Data of eight children treated for HMO Masada IIb forearm deformity at our hospital between 2015 and 2019 were collected from the hospital records and retrospectively reviewed. All patients underwent ulnar lengthening by distraction osteogenesis using either the Orthofix or Ilizarov external fixator. Range of movements at the elbow and wrist joints, and forearm supination/pronation, before and after the operation were recorded. Radiographs were evaluated by the Fogel method, and wrist joint function by the Krimmer method.
RESULTS: Follow-up radiographs showed significant improvement in relative ulnar shortening after treatment (pre-operative 9.23 ± 5.21 mm; post-operative 0.33 ± 4.13 mm). Changes in radial articular angle (pre-operative 33.55° ± 3.88° to 32.78° ± 6.57°) and carpal slip (pre-operative 45.00% ± 19.09%; post-operative 43.13% ± 16.68%) were not significant. Elbow flexion and extension, wrist flexion and extension, ulnar and radial deviation at wrist, and forearm rotation were significantly improved after surgery. Wrist function was graded as excellent in seven patients and as good in one patient. One patient treated with the Ilizarov external fixator had poor radial head reduction.
CONCLUSIONS: Ulnar lengthening with distraction osteogenesis is an effective treatment for HMO Masada IIb deformities. The optimum site for ulnar osteotomy appears to be at the proximal one-third to one-fourth of the ulna.
摘要：
目的：大约30％的遗传性多发性骨软骨瘤（HMO）患者前臂畸形和功能障碍。这项回顾性研究的目的是回顾我们对HMO和MasadaIIb前臂畸形儿童的手术治疗经验。
方法：从医院记录中收集2015年至2019年在我院接受HMOMasadaIIb前臂畸形治疗的8名儿童的数据，并进行回顾性分析。所有患者都使用Orthofix或Ilizarov外固定器通过牵张成骨进行尺骨延长。肘关节和腕关节的运动范围，和前臂旋后/内旋，手术前后均有记录。射线照片用福格尔方法评估，和腕关节功能的Krimmer方法。
结果：随访X线片显示治疗后尺骨相对缩短有明显改善（术前9.23±5.21mm；术后0.33±4.13mm）。桡骨关节角(术前33.55°±3.88°至32.78°±6.57°)和腕部滑脱(术前45.00%±19.09%;术后43.13%±16.68%)变化不显著。肘部屈伸,手腕屈伸,腕部尺骨和桡骨偏差，手术后前臂旋转明显改善。7例患者的腕关节功能被评为优秀，1例患者的腕关节功能被评为优秀。使用Ilizarov外固定器治疗的一名患者的桡骨头复位不良。
结论：尺骨延长牵张成骨是治疗HMOMasadaIIb畸形的有效方法。尺骨截骨的最佳位置似乎在尺骨的近端三分之一至四分之一。
方法：从医院记录中收集2015年至2019年在我院接受HMOMasadaIIb前臂畸形治疗的8名儿童的数据，并进行回顾性分析。所有患者都使用Orthofix或Ilizarov外固定器通过牵张成骨进行尺骨延长。肘关节和腕关节的运动范围，和前臂旋后/内旋，手术前后均有记录。射线照片用福格尔方法评估，和腕关节功能的Krimmer方法。
结果：随访X线片显示治疗后尺骨相对缩短有明显改善（术前9.23±5.21mm；术后0.33±4.13mm）。桡骨关节角(术前33.55°±3.88°至32.78°±6.57°)和腕部滑脱(术前45.00%±19.09%;术后43.13%±16.68%)变化不显著。肘部屈伸,手腕屈伸,腕部尺骨和桡骨偏差，手术后前臂旋转明显改善。7例患者的腕关节功能被评为优秀，1例患者的腕关节功能被评为优秀。使用Ilizarov外固定器治疗的一名患者的桡骨头复位不良。
结论：尺骨延长牵张成骨是治疗HMOMasadaIIb畸形的有效方法。尺骨截骨的最佳位置似乎在尺骨的近端三分之一至四分之一。
