桡骨短缩去旋转截骨皮下带蒂脂肪瓣填充治疗先天性尺桡骨融合  

Treatment of congenital radioulnar synostosis with radial derotational osteotomy and local subcutaneous pedicled fat flap filling in fusion area

作　　者：董延召[1] 呼鹏飞 刘福云[1] 牛学强[1] 冯国明[1] 王飞鹏 DONG Yanzhao;HU Pengfei;LIU Fuyun;NIU Xueqiang;FENG Guoming;WANG Feipeng(Department of Orthopedics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou Henan,450052,P.R.China;Department of Orthopedics,Zhengzhou People’s Hospital,Zhengzhou Henan,450000,P.R.China)

机构地区：[1]郑州大学第三附属医院骨科,郑州450052 [2]郑州市人民医院骨科,郑州450000

出　　处：《中国修复重建外科杂志》2020年第7期820-825,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南省科技厅重点研发与推广项目(182102310488)。

摘　　要：目的探讨桡骨短缩去旋转截骨钢板内固定局部皮下带蒂脂肪瓣填充分离融合区治疗先天性尺桡骨融合的疗效。方法回顾分析2014年2月—2018年6月收治的36例(41侧)先天性尺桡骨融合患儿,男21例,女15例;年龄2.5~4.5岁,平均3.1岁。前臂固定旋前位畸形30°~90°,平均71.6°;肘关节屈曲活动度120°~135°,平均128.2°。根据Cleary-Omer分型:Ⅱ型8侧,Ⅲ型17侧,Ⅳ型16侧。均采用桡骨近端短缩去旋转截骨钢板内固定局部皮下带蒂脂肪瓣填充分离融合区治疗。手术前后采用Broberg和Morrey肘关节评分标准对肘关节活动范围、肌力、关节稳定性、疼痛情况进行评分;采用Failla分级标准对患肢的日常生活能力进行评定。结果术后3例出现桡神经麻痹,2~4周神经功能恢复。36例患儿均获随访,随访时间6~52个月,平均38个月。截骨处均愈合,愈合时间5~12周,平均6.3周;取内固定物时可见带蒂脂肪瓣存活良好,位于尺桡骨之间。末次随访时,患肢肘关节屈曲活动度较术前未减少,前臂旋前和旋后活动度较术前改善。其中肘关节屈曲活动度为125°~135°,平均132.4°。前臂旋前活动度为15°~45°,平均30.1°;旋后活动度为10°~40°,平均22.6°。末次随访时Broberg和Morrey肘关节评分由术前(85.6±1.0)分提高至(91.8±1.8)分,差异有统计学意义(t=25.593,P=0.000)。根据Failla分级评定标准,术前良3侧、中9侧、差29侧,优良率7.3%;末次随访时优6侧、良28侧、中7侧,优良率82.9%;末次随访时较术前显著改善,差异有统计学意义(Z=-5.781,P=0.000)。结论应用桡骨短缩去旋转截骨钢板内固定局部皮下带蒂脂肪瓣填充分离融合区,可以恢复前臂部分旋转功能,提高患儿生活质量,是治疗先天性尺桡骨融合的一种有效手术方法。Objective To investigate the effectiveness of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation for the treatment of congenital radioulnar synostosis.Methods Between February 2014 and June 2018,36 patients(41 sides)with congenital radioulnar synostosis were analyzed retrospectively,including 21 males and 15 females,aged 2.5-4.5 years with an average of 3.1 years.The fixed pronation deformity of the forearm ranged from 30°to 90°with an average of 71.6°,and the range of motion of the elbow flexion was 120°-135°with an average of 128.2°.According to the Cleary-Omer classification,there were 8 sides of typeⅡ,17 sides of typeⅢ,and 16 sides of typeⅣ.All patients were treated by local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation.The range of motion of the elbow,muscle strength,joint stability,and patient discomfort were evaluated by using the Broberg and Morrey elbow scoring system preoperatively and postoperatively.In addition,the ability for daily living of the affected limb was evaluated by using the Failla grading standard.Results Radial nerve palsy occurred in 3 cases,and nerve function recovered at 2-4 weeks after operation.All the 36 cases were followed up 6-52 months,with an average of 38 months.All osteotomy sites healed,the healing time was 5-12 weeks(mean,6.3 weeks),and the pedicled fat flap between the radius and ulna survived when the internal fixation was taken.At last follow-up,the flexion range of motion of elbow joint was not decreased,and the pronation and supination range of motion of forearm were improved.The elbow flexion range of motion was 125°-135°with an average of 132.4°.The pronation range of motion of forearm was 15°-45°with an average of 30.1°,and the supination range of motion of forearm was 10°-40°with an average of 22.6°.At last follow-up,the Broberg and Morrey e

关 键 词：先天性尺桡骨融合 截骨术 带蒂脂肪瓣 内固定 

分 类 号：R687.3[医药卫生—骨科学]