尺骨横向短缩截骨治疗尺骨正向变异的临床分析

Clinical Analysis of Ulnar Transverse Shortening Osteotomy in Treatment of Ulnar Positive Variance

摘要: 目的：全面分析尺骨横向短缩截骨术治疗尺骨正向变异导致各种症状的临床效果。方法：回顾性分析2011年7月~2020年5月在我院采用尺骨横向短缩截骨术治疗尺骨正向变异引起各种症状25例的病例资料，通过比较其术前、术后的尺骨变异值、腕关节活动度、桡尺偏的范围、前臂旋转度、腕关节活动时疼痛程度、手握力、改良Sarmiento方法腕关节评分以及上肢功能DASH评分变化，对该术式临床效果进行评价。结果：25例均获随访，截骨部位均获得骨性愈合。比较其术前、术后的尺骨变异情况、腕关节活动度、桡尺偏的范围、前臂旋转度、手握力及上肢功能变化。术后尺骨正变异明显改善。腕关节的活动度有一定的好转，其中手握力、疼痛较术前改善明显；腕关节屈伸活动范围术前为健侧的(75.1 ± 10.1)%，术后为健侧的(89.1 ± 10.3)%；腕关节桡尺偏范围术前为健侧的(62.3 ± 7.9)%，术后为健侧的(87.8 ± 11.2)%；前臂旋转活动范围术前为健侧的(76.3 ± 8.2)%，术后为健侧的(91.8 ± 8.1)%；握力术前为健侧的(62.1 ± 10.1)%，术后为(90.2 ± 9.5)%；疼痛VAS评分术前为(4.6 ± 1)分，术后为(0.7 ± 0.5)分。最后一次随访时改良的Sarmiento腕关节评分平均为89.1分，优16例，良6例，可2例，差1例，优良率为88.0%。此外，术后上肢DASH评分(55.1 ± 9.5)分较术前(25.2 ± 8.7)分显著降低。结论：尺骨横向短缩截骨术治疗尺骨正向变异引起的各种症状，可缓解患者腕部疼痛，改善腕关节功能，提高手握力，是一种有效的治疗方法。

Abstract: Objective: To comprehensively analyze the clinical efficiency of ulnar transverse shortening os-teotomy in the treatment of ulnar positive variance’s various symptoms. Methods: Retrospective analysis of medical records of 25 patients with ulnar positive variance’s various symptoms were treated in our hospital with transverse shortening osteotomy of the ulnar from July 2011 to May 2020, the preoperative and postoperative ulnar variation, wrist joint activity, radioulnar deviation range, forearm rotation degree, pain degree at wrist activity, handgrip strength, modified Sarmiento wrist score and change of upper limb function DASH score were compared to evaluate the clinical effect of the surgery. Results: 25 patients were fully followed up. All patients achieved bone healing. The changes in the preoperative and postoperative ulnar variation, wrist joint activity, radioulnar deviation range, forearm rotation degree, handgrip strength and upper limb function were compared. The positive variation of ulna was significantly improved after surgery. The mobility of the wrist was improved to some extent, especially hand grip strength and pain significantly compared with that before surgery. The range of motion to the healthy side gained limited increments from (75.1 ± 10.1)% to (89.1 ± 10.3)% for wrist flexion-extension, from (62.3 ± 7.9)% to (87.8 ± 11.2)% for radioulnar deviation, and from (76.3 ± 8.2)% to (91.8 ± 8.1)% for forearm rotation. The grip strength to the healthy side increased from (62.1 ± 10.1)% to (90.2 ± 9.5)%. The pain VAS score reduced from (4.6 ± 1.2)% to (0.7 ± 0.5). At the last follow-up, the modified Sarmiento to wrist score averaged 89.1 points, with 16 excellent, 6 good, 2 fair and 1 poor. The excellent and good rate was 88.0%. Besides, the DASH score of upper limb function after surgery was obviously decreased compared with that before surgery (55.1 ± 9.5) points vs. (25.2 ± 8.7) points. Conclusion: Ulnar transverse shortening osteotomy in the treatment of ulnar positive variance’s various symptoms can alleviate wrist pain, improve wrist joint function and enhance handgrip strength. It’s an effective treatment.