9例盖氏骨折术后骨不连合并下尺桡关节炎的疗效分析
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摘要
目的:探讨手术治疗盖氐骨折术后骨不连合并下尺桡关节炎的方法和临床疗效。方法:对2010年1月至2015年6月收治的9例盖氐骨折术后骨不连合并下尺桡关节炎患者的临床资料进行回顾性分析,评价其骨不连愈合率、前臂旋转活动度,采用DASH问卷评估上肢功能,记录术中及术后并发症的发生情况。结果:9例患者随访13-78个月,平均45.4个月所有骨不连在24周都获得愈合,愈合时间12-24周;术后前臂旋转功能平均115.56±26.74°,显著高于术前(P<0.01);而DASH评分从术前48.56±8.71分降至20.11±8.08分(P<0.05);根据Anderson前臂功能评分标准,优2例,良5例,中2例,优良率为77.8%所有患者均对手术效果十分满意。结论:尺骨头切除术联合桡骨切开植骨内固定术操作简单有效,可显著改善盖氐骨折术后骨不连合并下尺桡关节炎患者的上肢功能。
Objective:To investigate the clinical efficacy and treatment of radius nonunion and Arthritis of the Distal Radioulnar Joint(DRUJ) after Galeazzi fracture surgery.Methods:We retrospectively analyzed the clinical data of 9 cases with radius nonunion and Arthritis of the DRUJ after Galeazzi fracture who were treated in our department from January 2010 to June 2015.Follow-up included bone union rate,forearm active range of motion(AROM),the Disabilities of the Arm,Shoulder and Hand(DASH) questionnaire,intra-operative and postoperative complications.Results:we reviewed all patients at an average 45.4 months(range,13to78 months) after surgery;Bony union was achieved between 12 and 24 weeks after operation;The AROM of the treated forearm averaged 115.56±26.74° for pronation and supination,which significantly better than preoperative(P<0.01);The mean DASH score decreased from48.56±8.71 to 20.11±8.08 postoperatively(P<0.05);According to the criteria of Anderson et al,there were excellent in 2 cases,good in 5,fair in 2,the excellent and good rate was 77.8%;Overall,patient satisfaction was high and 9 patients(100%) would choose to undergo the operation again.Conclusion:This study demonstrated that ulnar head resection plus combining an autograft with a plate for radius nonunion appears to be a technically easy and reliable procedure,and yield good upper limb functional outcome for the patients of radius nonunion and arthritis of the distal radioulnar joint after galeazzi fracture.
Objective:To investigate the clinical efficacy and treatment of radius nonunion and Arthritis of the Distal Radioulnar Joint(DRUJ) after Galeazzi fracture surgery.Methods:We retrospectively analyzed the clinical data of 9 cases with radius nonunion and Arthritis of the DRUJ after Galeazzi fracture who were treated in our department from January 2010 to June 2015.Follow-up included bone union rate,forearm active range of motion(AROM),the Disabilities of the Arm,Shoulder and Hand(DASH) questionnaire,intra-operative and postoperative complications.Results:we reviewed all patients at an average 45.4 months(range,13to78 months) after surgery;Bony union was achieved between 12 and 24 weeks after operation;The AROM of the treated forearm averaged 115.56±26.74° for pronation and supination,which significantly better than preoperative(P<0.01);The mean DASH score decreased from48.56±8.71 to 20.11±8.08 postoperatively(P<0.05);According to the criteria of Anderson et al,there were excellent in 2 cases,good in 5,fair in 2,the excellent and good rate was 77.8%;Overall,patient satisfaction was high and 9 patients(100%) would choose to undergo the operation again.Conclusion:This study demonstrated that ulnar head resection plus combining an autograft with a plate for radius nonunion appears to be a technically easy and reliable procedure,and yield good upper limb functional outcome for the patients of radius nonunion and arthritis of the distal radioulnar joint after galeazzi fracture.
引文
[1]Kloen P,Buijze GA,Ring D.Management of forearm nonunions:current concepts[J].Strategies Trauma Limb Reconstr,2012,7(1):1-11
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[5]Malone PS,Cooley J,Morris J,et al.The biomechanical and functional relationships of the proximal radioulnar joint,distal radioulnar joint,and interosseous ligament[J].J Hand Surg Eur Vol,2015,40(5):485-493
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[7]Jochen-Frederick H,Pouyan Y,Khosrow BA,et al.Long-term functional outcome and patient satisfaction after ulnar head resection[J].J Plast Reconstr Aesthet Surg,2016,69(10):1417-1423
[8]Lluch A.The sauvé-kapandji procedure[J].J Wrist Surg,2013,2(1):33-40
[9]Axelsson P,Sollerman C,Krrholm J.Ulnar Head Replacement:21Cases;Mean Follow-Up,7.5 Years[J].J Hand Surg Am,2015,40(9):1731-1738
[10]Galvis EJ,Pessa J,Scheker LR.Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis[J].J Hand Surg Am,2014,39(9):1699-1704
[11]Darrach W.Partial excision of lower shaft of ulna for deformity following Colles's fracture.1913[J].Clin Orthop Relat Res,1992,(275):3-4
[12]Grawe B,Heincelman C,Stern P.Functional results of the Darrach procedure:a long-term outcome study[J].J Hand Surg Am,2012,37(12):2475-2480.e1-2
[13]Yu YD,Wu T,Tian FT,et al.Ulnar impaction syndrome with different operative methods:a comparative biomechanical study[J].Int J Clin Exp Med,2015,8(4):5715-5722
[14]Kawabata A,Egi T,Tsuboi H,et al.Modified Sauvé-Kapandji procedure for rheumatoid wrists:a long-term study with a minimum follow-up of 5 years[J].Mod Rheumatol,2014,24(3):426-429
[15]Nikkhah D,Rodrigues J,Dejager L.Do patients really do better after the Sauve-Kapandji procedure when compared to the Darrach procedure?A systematic review[J].J Hand Surg Eur Vol,2011,36(7):615
[16]Sauerbier M,Hahn ME,Berglund LJ,et al.Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection,two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation[J].Arch Orthop Trauma Surg,2011,131(1):15-26
[17]Sauerbier M,Arsalan-Werner A,Enderle E,et al.Ulnar head replacement and related biomechanics[J].J Wrist Surg,2013,2(1):27-32
[18]Zimmerman RM,Kim JM,Jupiter JB.Arthritis of the distal radioulnar joint:from Darrach to total joint arthroplasty[J].J Am Acad Orthop Surg,2012,20(10):623-632
[19]Morrey BF,Askew LJ,Chao EY.A biomechanical study of normal functional elbow motion[J].J Bone Joint Surg Am,1981,63(6):872-877
[20]Lapcin O,Arkan,Yavuz U,et al.Evaluation of outcomes in aseptic non-unions of the forearm bones in adults treated with LCP and autograft[J].Ulus Travma Acil Cerrahi Derg,2016,22(3):283-289
[21]Allsopp BJ,Hunter-Smith DJ,Rozen WM.Vascularized versus Nonvascularized Bone Grafts:What Is the Evidence?[J].Clin Orthop Relat Res,2016,474(5):1319-1327
[2]Anderson LD,Sisk D,Tooms RE,et al.Compression-plate fixation in acute diaphyseal fractures of the radius and ulna[J].J Bone Joint Surg Am,1975,57(3):287-297
[3]Atesok KI,Jupiter JB,Weiss AP.Galeazzi fracture[J].J Am Acad Orthop Surg,2011,19(10):623-633
[4]Lees VC.of the distal radioulnar joint in health and disease[J].Ann R Coll Surg Engl,2013,95(3):163-170
[5]Malone PS,Cooley J,Morris J,et al.The biomechanical and functional relationships of the proximal radioulnar joint,distal radioulnar joint,and interosseous ligament[J].J Hand Surg Eur Vol,2015,40(5):485-493
[6]Mulford JS,Axelrod TS.Traumatic injuries of the distal radioulnar joint[J].Hand Clin,2010,26(1):155-163
[7]Jochen-Frederick H,Pouyan Y,Khosrow BA,et al.Long-term functional outcome and patient satisfaction after ulnar head resection[J].J Plast Reconstr Aesthet Surg,2016,69(10):1417-1423
[8]Lluch A.The sauvé-kapandji procedure[J].J Wrist Surg,2013,2(1):33-40
[9]Axelsson P,Sollerman C,Krrholm J.Ulnar Head Replacement:21Cases;Mean Follow-Up,7.5 Years[J].J Hand Surg Am,2015,40(9):1731-1738
[10]Galvis EJ,Pessa J,Scheker LR.Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis[J].J Hand Surg Am,2014,39(9):1699-1704
[11]Darrach W.Partial excision of lower shaft of ulna for deformity following Colles's fracture.1913[J].Clin Orthop Relat Res,1992,(275):3-4
[12]Grawe B,Heincelman C,Stern P.Functional results of the Darrach procedure:a long-term outcome study[J].J Hand Surg Am,2012,37(12):2475-2480.e1-2
[13]Yu YD,Wu T,Tian FT,et al.Ulnar impaction syndrome with different operative methods:a comparative biomechanical study[J].Int J Clin Exp Med,2015,8(4):5715-5722
[14]Kawabata A,Egi T,Tsuboi H,et al.Modified Sauvé-Kapandji procedure for rheumatoid wrists:a long-term study with a minimum follow-up of 5 years[J].Mod Rheumatol,2014,24(3):426-429
[15]Nikkhah D,Rodrigues J,Dejager L.Do patients really do better after the Sauve-Kapandji procedure when compared to the Darrach procedure?A systematic review[J].J Hand Surg Eur Vol,2011,36(7):615
[16]Sauerbier M,Hahn ME,Berglund LJ,et al.Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection,two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation[J].Arch Orthop Trauma Surg,2011,131(1):15-26
[17]Sauerbier M,Arsalan-Werner A,Enderle E,et al.Ulnar head replacement and related biomechanics[J].J Wrist Surg,2013,2(1):27-32
[18]Zimmerman RM,Kim JM,Jupiter JB.Arthritis of the distal radioulnar joint:from Darrach to total joint arthroplasty[J].J Am Acad Orthop Surg,2012,20(10):623-632
[19]Morrey BF,Askew LJ,Chao EY.A biomechanical study of normal functional elbow motion[J].J Bone Joint Surg Am,1981,63(6):872-877
[20]Lapcin O,Arkan,Yavuz U,et al.Evaluation of outcomes in aseptic non-unions of the forearm bones in adults treated with LCP and autograft[J].Ulus Travma Acil Cerrahi Derg,2016,22(3):283-289
[21]Allsopp BJ,Hunter-Smith DJ,Rozen WM.Vascularized versus Nonvascularized Bone Grafts:What Is the Evidence?[J].Clin Orthop Relat Res,2016,474(5):1319-1327