背景:尺骨缩短截骨术(USO)是治疗尺骨嵌塞综合征的有效方法。然而,有报道对有反向斜向乙状结肠切迹的患者进行USO时,桡尺远侧关节(DRUJ)发生骨关节炎(OA).这项研究旨在评估USO后反向斜乙状结肠切迹患者的影像学和功能结果。
方法:我们回顾性分析了2002年至2013年期间因尺骨嵌塞综合征而接受USO治疗的乙状结肠倒斜切迹患者。我们评估了DRUJ的影像学变化和患者的功能结局。
结果:我们招募了22名患者(22个手腕),平均年龄49.6岁,平均随访93.2(范围,36-179;标准偏差[SD],38.2)月。我们发现乙状结肠缺口的倾角有变化,从14.9o的平均反向倾斜(范围,11o-23o;SD,3.4o)术前更平行的5.1o(范围,0o-11o;SD,3.2o)在最后的后续行动中。最终随访的功能结果良好,疼痛的平均视觉模拟评分为0.2(范围,0-1;SD,0.4)静止时和1.3(范围,0-3;SD,0.9)活动期间,QuickDASH为15.1(范围,2.3-34.1;SD,8.8),并修改了梅奥手腕评分91.6(范围,70-100;SD,6.4).七个手腕(31.8%)的变化与OA兼容,但是与没有OA变化的手腕相比,手腕没有表现出明显更差的功能,除了旋后运动和握力。
结论:对于USO后出现反向斜乙状结肠倾斜的患者,我们观察到倾斜角度有平行趋势,部分患者在DRUJ出现OA.然而,长期功能结果可能仍然良好。反向倾斜的乙状结肠倾斜似乎不是USO的绝对禁忌症。
BACKGROUND: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been
reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a
reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a
reverse oblique sigmoid notch.
METHODS: We retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients.
RESULTS: We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36-179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average
reverse oblique of 14.9o (range, 11o-23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o-11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0-1; SD, 0.4) at rest and 1.3 (range, 0-3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3-34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70-100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength.
CONCLUSIONS: For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The
reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.