单骨前臂是一种由于严重创伤而导致大量骨质流失的抢救技术,恶性肿瘤,感染或先天性畸形。还描述了治疗影响尺骨远端的遗传性多发性外生骨疾病的后遗症。我们介绍一个29岁的病人,通过改良的单骨前臂技术治疗左前臂遗传性多发性外生性骨病的后遗症。病人,右撇子,儿童时期曾两次手术治疗遗传性多发性外生性外生性外生性外生性疾病:不完全切除尺骨远端的外生性外生性外生性外生性外生性外生性外生性外生性外生性外生性外生性外生性外生性外生性外生性外生性外骨外生性外骨外生性外骨外生性外生性外生性外生没有改进。患者出现左前臂变形,与右侧相比缩短。显著限制了前旋前(前旋前15°,旋光20°)。肘部弯曲110°,伸展不足15°。腕部弯曲50°和伸展50°,径向倾斜25°和尺骨30°。根据视觉模拟评分(VAS),疼痛评分为3分,尤其是努力。Dash得分为31,82/100。我们选择了单骨前臂技术。术后立即结果发现前臂重新对齐,没有神经或血管损伤。合并在四个月内获得。五个月后,患者在110°和完全伸展时恢复肘部屈曲,手腕弯曲45°,伸展50°。径向倾斜20°和尺骨25°。已经描述了单骨前臂技术,不仅用于治疗遗传性多发性骨外生病,但也适用于严重的创伤或大量骨质流失的肿瘤。该技术通常包括桡骨和尺骨的截骨术,将桡骨固定在尺骨上,形成一个突骨,切除或不切除前臂的一个或两个骨骼的一部分。最常见的单骨前臂手术并发症是疼痛,与先前受伤继发的软组织相关的并发症,和感染。单骨前臂仍然是前臂骨大量丢失的抢救技术,或先天性畸形导致的大畸形。这种技术可以切除大量的骨头,只保留一部分尺骨和桡骨,具有功能维护和美观的前臂保存。
The single-bone forearm is a salvage technique for massive loss of bone due to serious trauma, malignant tumors, infections or congenital deformity. It is also described to treat the sequelae of hereditary multiple exostoses disease that affects the distal end of the ulna. We present the case of a 29-year-old patient, operated for sequelae of hereditary multiple exostoses disease of the left forearm by a modified single-bone forearm technique. The patient, right-handed, operated on twice in childhood for a hereditary multiple exostoses disease of the left forearm: incomplete excision of the exostosis of the distal end of the ulna and lengthening of this last on external fixator, without improvement. The patient presented for a deformation of the left forearm with shortening compared to the right side. Significant limitation of prono-supination (pronation 15°, supination 20°). Elbow flexion at 110° and extension with deficit of 15°. Wrist flexion at 50° and extension at 50°, radial inclination at 25° and ulnar at 30°. The pain score was 3 according to the Visual Analogue Scale (VAS), especially on effort. Dash score was 31,82/100. We chose the forearm technique with a single bone. The immediate postoperative result found a realignment of the forearm, without neurological or vascular damages. Consolidation was obtained in four months. At five months, the patient recovered elbow flexion at 110° and full extension, wrist flexion at 45° and extension at 50°. Radial inclination at 20° and ulnar at 25°. The single-bone forearm technique has been described, not only for the treatment of hereditary multiple exostoses disease, but also for serious trauma or tumors with massive loss of bone. The technique generally consists of an osteotomy of the radius as well as the ulna, fixing the radius to the ulna creating a synostosis, with or without resection of part of one or both bones of the forearm. The most described complications of single-bone forearm procedure are pain, complications related to soft tissue secondary to the previous injury, and infections. The one-bone forearm remain a salvage technique for massive loss of bone of the forearm, or large deformities due to congenital malformations. This technique could allow the excision of massive bone and keep only a part of the ulna and the radius, with function maintenance and aesthetic forearm preservation.