Orthopaedics & Traumatology: Surgery & Research ( IF 2.3 ) Pub Date : 2022-08-05 , DOI: 10.1016/j.otsr.2022.103374 Pierre-Antoine Guillaume 1 , Nicolas Mainard 2 , Federico Canavese 2 , Matthieu Baudoux 2 , Aurélie Mézel 2 , Christophe Chantelot 1 , Marc Saab 1
Introduction
Madelung's deformity is a rare congenital condition of the wrist that can cause pain, aesthetic concerns, reduced range of motion and grip strength. Currently, there is no consensus on the optimal age for surgery or whether operative procedures can be isolated or combined depending on the extent of the deformity. The main objective of our study was to analyze the postoperative functional clinical results at a minimum of 3-years follow-up in patients operated on for Madelung's deformity. The secondary objectives were (1) comparison of preoperative and postoperative radiographic parameters, and (2) to assess whether certain preoperative radiographic parameters influence the choice of surgical procedure.
Hypothesis
The surgery offered at our center achieves clinical and radiological result necessary for long-term activities of daily living, and varies according to the severity of the distal radial deformity.
Patients and methods
We carried out a retrospective observational monocentric study including patients operated on between 2004 and 2016. Clinical (VAS, mobility), functional (PRWE score), and radiographic assessments were performed before and after the last follow-up.
Results
The study included 11 patients (12 wrists) with a mean age of 17 ± 7.3 years and a mean follow-up of 8.1 years (4–12.3). The mean VAS was 2.3 (0–6) and the mean PRWE score was 37 (0–108). The mean flexion-extension arc was 134° and that of pronation and supination was 142°. The mean grip strength was 25.8 ± 11.8 kg. Four out of 6 radiographic criteria were significantly improved. An isolated radial osteotomy or combined radioulnar osteotomy was performed when the sagittal radial tilt was greater than 30° and protrusion of the lunate greater than 5 mm, otherwise below these values, an isolated ulnar osteotomy was performed.
Discussion
Our center offers surgical management of Madelung's deformity by osteotomy which improves the majority of postoperative radiographic parameters and gives satisfactory clinical and radiographic results after a mean follow-up of 8.1 years. The surgery is influenced by the severity of the distal radial deformity, including protrusion of the lunate and sagittal radial tilt.
Level of evidence
IV, Retrospective study.
中文翻译:
单独或联合桡尺骨截骨术治疗马德隆畸形患者的中长期功能和影像学结果
介绍
马德隆畸形是一种罕见的手腕先天性疾病,可导致疼痛、美观问题、运动范围和握力下降。目前,对于手术的最佳年龄以及是否可以根据畸形的程度单独或组合手术程序尚未达成共识。我们研究的主要目的是分析接受马德隆畸形手术的患者至少 3 年随访的术后功能临床结果。次要目标是 (1) 比较术前和术后放射学参数,以及 (2) 评估某些术前放射学参数是否影响手术程序的选择。
假设
我们中心提供的手术可达到长期日常生活活动所需的临床和放射学结果,并根据桡骨远端畸形的严重程度而有所不同。
患者和方法
我们进行了一项回顾性观察性单中心研究,包括 2004 年至 2016 年间接受手术的患者。在最后一次随访前后进行了临床(VAS、活动度)、功能(PRWE 评分)和影像学评估。
结果
该研究包括 11 名患者(12 个手腕),平均年龄为 17 ± 7.3 岁,平均随访时间为 8.1 年 (4–12.3)。平均 VAS 为 2.3 (0–6),平均 PRWE 评分为 37 (0–108)。平均屈伸弧度为134°,旋前和旋后弧度为142°。平均握力为 25.8 ± 11.8 kg。6 项射线照相标准中有 4 项得到显着改善。当矢状面径向倾斜度大于 30° 且月骨前突大于 5 mm 时,进行单独的桡骨截骨术或联合桡尺骨截骨术,否则进行单独的尺骨截骨术。
讨论
我们的中心通过截骨术对马德隆畸形进行手术治疗,改善了大部分术后放射学参数,并在平均随访 8.1 年后获得了令人满意的临床和放射学结果。手术受桡骨远端畸形的严重程度影响,包括月骨突出和矢状桡骨倾斜。
证据等级
四、回顾性研究。