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首页> 外文期刊>Journal of Hand Surgery. American Volume >Arthroscopically guided osteotomy for management of intra-articular distal radius malunions.
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Arthroscopically guided osteotomy for management of intra-articular distal radius malunions.

机译：关节镜引导截骨术治疗关节内远端radius骨畸形。

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摘要

PURPOSE: A malunion with a step-off of 1 mm or more after an intra-articular distal radius fracture may cause pain and arthritic changes at midterm follow-up. We present our technique for treating intra-articular distal radius malunions by carrying out an osteotomy from inside the joint outward under arthroscopic guidance using the dry arthroscopy technique, with emphasis on the clinical and radiologic outcomes. METHODS: We performed surgery on 11 patients for intra-articular malunion of the distal radius 1 to 5 months after the injury. Preoperative step-offs ranged from 2 to 5 mm (average, 2.5 mm) on plain radiographs. Original fracture patterns involved 1 radial styloid fracture, 1 radiocarpal fracture-dislocation, and 9 comminuted intra-articular fractures. In 5 cases an anterior-ulnar or radial styloid fragment was repositioned. In the rest, more than 1 fragment (up to 3) was osteotomized. In 1 patient the articular osteotomy was combined with an ulnar shortening osteotomy. RESULTS: Follow-up ranged from 12 to 48 months. Step-offs were reduced in most cases to 0 mm; however, localized gaps (<2 mm) and cartilage defects were commonly seen intraoperatively because the fragments did not accurately fit. According to the Gartland and Werley score, there were 4 excellent and 7 good results (mean score of 2.8). The Modified Green and O'Brien system achieved a mean score of 83, with 3 excellent, 5 good, and 3 fair results. One patient showed radiolunate narrowing on follow-up radiographs. CONCLUSIONS: Arthroscopically assisted osteotomy permits direct visualization of the osteotomy site with good midterm clinical and radiologic outcomes. The technique can be used in irregularly defined fragments. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
机译：目的：关节内远端radius骨骨折后步距小于或等于1 mm的畸形畸形可能在中期随访时引起疼痛和关节炎改变。我们介绍了我们的技术，通过使用干式关节镜技术在关节镜引导下从关节内向外进行关节切开术，从而治疗了关节内远端distal骨畸形，重点是临床和放射学结果。方法：我们对11例患者在受伤后1至5个月内进行了radius骨远端畸形关节内畸形手术。在平片上，术前分步范围为2到5毫米（平均2.5毫米）。原始骨折类型包括1个radial骨茎突骨折，1个radio腕骨折脱位和9个粉碎性关节内骨折。 5例重新定位尺骨或radial骨茎突。其余的，截骨超过1个（最多3个）。在1例患者中，关节截骨术与尺骨缩短截骨术相结合。结果：随访时间为12至48个月。在大多数情况下，步距减小到0 mm;然而，由于碎片不能准确地吻合，因此在术中通常见到局部间隙（<2 mm）和软骨缺损。根据Gartland和Werley评分，有4项优秀结果和7项良好结果（平均分2.8）。改良的Green和O'Brien系统获得了83分的平均得分，其中3个优异，5个良好和3个公平结果。一名患者在X线片上显示出放射状的变窄。结论：关节镜辅助截骨术可直接观察截骨部位，具有良好的中期临床和放射学结果。该技术可用于不规则定义的片段。研究类型/证据级别：治疗IV。

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