保留骨膜的尺骨远端切除术的疗效分析研究

摘要

Objective To explore the feasibility and clinical efficacy of distal ulna resection with periosteum preservation to enhance the stability of ulnar stump. Methods A retrospective study was conducted on 26 cases of old distal radioulnar joint dislocation or total carpal arthritis treated with distal ulna resection with periosteum preservation. The joint pain, active rotation range of forearm and the X-ray radiograph were evaluated postoperatively to observe the clinical efficacy. The feasibility, indications and key points of the method for stabilizing ulnar stump were analyzed. Results All the patients were follow-up for 3 to 39 months with an average of 8.5 months. All the wounds all achieved primary healing. The postoperative visual analogue scale (VAS) and active rotation range of forearm were improved significantly (P<0.05). The significant ossification of ulnar stump was found in 10 cases and it was limited within the reserved periosteum. The length of ossification was significantly positively correlated with the length of the osteotomy of the ulnar distal part (P<0.05). The radioulnar convergence was found in 6 cases in different degrees, but no radioulnar impingement was identified. The reserved periosteum played a stable role in the suspension of the ulnar stump. No volar or distal deviation and excessive osteogenesis of the ulnar stump was observed from the X-ray film. Conclusion The distal ulna resection with periosteum preservation can significantly improve the joint pain as well as the function of forearm rotation in the patients with distal radioulnar joint injuries. The reserved periosteum has a good stabilizing effect on the ulnar stump, which can effectively avoid the occurrence of related complications. The ossification of ulnar stump has no influence on the forearm function.%目的 探讨保留骨膜的尺骨远端切除术对于增加尺骨残端稳定性作用的可行性及临床疗效.方法 我们对26例采用保留骨膜的尺骨远端切除术治疗陈旧性桡尺远侧关节脱位或全腕关节炎的患者进行回顾性研究,从疼痛、前臂主动旋转活动范围及X线片表现等方面随访和统计临床疗效,分析该方法对稳定尺骨残端的可行性、适应证及手术要点.结果 术后所有患者均获得随访,时间3～39个月,平均8.5个月,伤口均Ⅰ期愈合.术后患者疼痛评分、前臂旋转活动度均有明显改善,差异具有统计学意义(P<0.05).本组中10例出现尺骨残端骨化,骨化均位于保留的骨膜范围内,骨化长度与尺骨远端的截骨长度呈显著正相关(P<0.05).6例出现不同程度尺骨残端向桡侧偏移,但均未发现桡尺撞击X线表现,残留骨膜组织对尺骨残端起到了悬吊稳定作用.所有病例随访X线片均未发现尺骨残端向掌、背侧偏移,也未发现残端过度成骨.结论 保留骨膜的尺骨远端切除术能够显著改善桡尺远侧关节损伤患者的疼痛及前臂旋转功能,保留的骨膜对尺骨残端具有较好的稳定作用,能够有效避免相关并发症的出现,残端骨化对前臂功能没有影响.