吕秉乐;李东升;田亚敏;滕军燕;
LV Bingle;LI Dongsheng;TIAN Yamin;TENG Junyan;Department of Bone Disease and Orthopedics,Luoyang Orthopedic-Traumatological Hospital of Henan Province & Henan Provincal Orthopedic Hospital;

• 1:河南省洛阳正骨医院&河南省骨科医院骨病矫形科

摘要(Abstract)：

目的:探讨Ilizarov技术在骨软骨瘤继发前臂畸形中的治疗效果。方法:收集28例遗传性多发性骨软骨瘤(HMO)继发前臂畸形病例,应用尺骨远端骨软骨瘤切除、尺骨中段微创截骨Ilizarov骨延长技术进行治疗,观察患者尺骨延长长度,记录并分析腕关节屈伸、腕关节桡偏尺偏以及肘关节屈伸活动度、前臂旋前旋后度数、尺骨方差、桡骨关节面角度及腕骨滑动度,在末次随访时采用改良Green和OBrien腕关节功能评分标准和Mayo肘关节功能评分标准对腕、肘关节功能进行评估。结果:所有病例均获得随访,尺骨延长25～68 mm;与术前比较,腕关节桡偏、尺偏活动度及前臂旋前、旋后度数增加(P <0.05),尺骨方差、腕骨滑动度较术前减少,桡骨关节角度较术前增加(P <0.05);与术前比较,末次随访时的腕关节功能改良Green和OBrien评分和肘关节功能Mayo评分增加(P <0.05)。结论:Ilizarov技术治疗对骨软骨瘤继发前臂畸形的疗效肯定。
Objective: To investigate the effect of Ilizarov technique in the treatment of forearm deformity caused by osteochondroma. Methods: 28 cases of hereditary multiple osteochondroma( HMO) with secondary forearm deformity were collected,and all the cases were treated with with distal ulnar osteochondroma resection and minimally invasive osteotomy Ilizarov bone lenthening in the middle of the ulna. The flexion and extension of the wrist,radial and ulnar deviation of the wrist,elbow flexion and extension,and forearm rotation were observed and recorded,and the variance of ulna,radial joint angle and carpal bone slide were measured. In the last time of follow-up,the wrist functions were measured using modified Green and OBrien scores,and the elbow functions were measured using Mayo scores. Results: All the cases were followed up. The ulna was lengthened 25 ～68 mm,the radial and ulnar deviation of the wrist and forearm rotation were better than before treatment and the difference was statistically significant( P < 0. 05). The variance of ulna,radial joint angle and carpal bone slide were better than before treatment and the difference was statistically significant( P < 0. 05). After treatment,the Green and OBrien scores and Mayo scores increased more than before treatment and the difference was statistically significant( P < 0. 05). Conclusion: Ilizarov bone lengthening technique is effective in treating secondary forearm deformity of osteochondroma.

关键词(KeyWords)： 骨软骨瘤;桡骨;尺骨;Ilizarov技术;骨延长术;前臂畸形;遗传性多发性骨软骨瘤;骨干续连症
osteochondroma;radius;ulna;Ilizarov technique;bone lengthening;forearm deformity;hereditary multiple osteochondroma(HMO);diaphyseal aclasis

Abstract:

Keywords:

基金项目(Foundation): 河南省中医药科学研究专项(2015ZY01002)

作者(Authors): 吕秉乐;李东升;田亚敏;滕军燕;
LV Bingle;LI Dongsheng;TIAN Yamin;TENG Junyan;Department of Bone Disease and Orthopedics,Luoyang Orthopedic-Traumatological Hospital of Henan Province & Henan Provincal Orthopedic Hospital;

DOI: 10.19367/j.cnki.2096-8388.2020.10.021

参考文献(References)：

• [1]赵仁欢，卢宾，刘昕，等．尺骨截骨Orthofix外固定支架延长术治疗儿童尺骨干骺端续连症[J]．中医正骨，2017,29(1):56-59.
• [2] SHINOHARA D,YASUDA T,ARAI M,et al. A longstanding monteggia fracture in a child who underwent bone lengthening and annular ligament reconstruction:a case report[J]. Orthop Case Rep,2019,9(3):30-33.
• [3] ISA A D,MCGREGOR M E,PADMORE C E,et al.Effect of radial lengthening on distal forearm loading following simulated in vitro radial shortening during simulated dynamic wrist motion[J]. Hand Surg Am,2019,44(7):556-563.
• [4]FLIPSEN M,HAM J S,VANDERZWAN A L,et al. Radial head resection and hemi-interposition arthroplasty in patients with multiple hereditary exostoses:description of a new surgical technique[J]. J Pediatr Orthop B,2018,27(4):289-295.
• [5]张力，秦泗河，石磊，等．Ilizarov外固定技术治疗多发性骨软骨瘤致前臂畸形[J]．中国矫形外科杂志，2019(13):1217-1220.
• [6]COONEY W P,BUSSEY R,DOBYNS J H,et al. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist[J]. Clin Orthop Relat Res,1987(214):136-47.
• [7]MORREY B F,ADAMS R A. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow[J]. Bone Joint Surg Am,1992,74(4):479-490.
• [8]KLEIN C,FERRARI V,DEROUSSEN F,et al. Forearm lengthening and prosthetic management in children with transverse congenital forearm deficiency[J]. Hand Surg Rehabil,2019,38(2):129-134.
• [9]PEYMANI A,JOHNSON A R,DOWLATSHAHI A S,et al.Surgical management of madelung deformity:a systematic review[J]. Hand(NY),2018,(13):1558944718793179.
• [10]AHMED A. Gradual ulnar lengthening by an Ilizarov ring fixator for correction of Masada IIb forearm deformity without tumor excision in hereditary multiple exostosis:preliminary results[J]. Pediatr Orthop B,2019,28(1):67-72.
• [11]LI Y,HAN B,TANG J,et al. Identification of risk factors affecting bone formation in gradual ulnar lengthening in children with hereditary multiple exostoses:a retrospective study[J]. Medicine(Baltimore),2019,98(5):e14280.
• [12]AITA M A,RODRIGUES F L,BERNARDO R M,et al.Ulnar lengthening/reconstruction of interosseous membrane in treatment of osteochondroma[J]. Wrist Surg,2018,7(2):160-164.
• [13]ERICKSON L A,INWARDS C Y. Multiple hereditary osteochondromas[J]. Mayo Clin Proc,2019,94(7):1388-1389.
• [14]D'ARIENZO A,ANDREANI L,SACCHETTI F,et al. Hereditary multiple exostoses:current insights[J]. Orthop Res Rev,2019,(11):199-211.
• [15]PACIFICI M. Hereditary multiple exostoses:are there new plausible treatment strategies[J]. Expert Opin Orphan Drugs,2018,6(6):385-391.
• [16]PHAN A Q,PACIFICI M,ESKO J D. Advances in the pathogenesis and possible treatments for multiple hereditary exostoses from the 2016 international MHE conference[J]. Connect Tissue Res,2018,59(1):85-98.
• [17]陈嘉辉，孙春汉，夏贤生，等．单臂外固定架尺骨延长治疗儿童骨干续连症9例报告[J]．实用骨科杂志，2019(4):360-362.
• [18]MWATURURA T,CLOUTIER F C,DANESHVAR P. Analysis of radiographic relationship between distal radius,ulna and lunate[J]. J Wrist Surg,2019,8(5):374-379.

文章评论(Comment)：