Clinical efficacy analysis of ulnar head metaphyseal osteotomy and ulnar shaft osteotomy with internal fixation in the treatment of ulnocarpal impaction syndrome
Objective To investigate the clinical efficacy of ulnar head metaphseal shortening osteotomy by hollow nail internal fixation and ulnar shaft shortening osteotomy by plate internal fixation in the treatment of ulnocarpal impaction syndrome.Methods From February 2015 to August 2021,34 patients with ulnocarpal impaction syndrome were treated.They were divided into two groups according to surgical methods:the metaphyseal osteotomy group(using hollow screws for internal fixation of the ulnar head metaphyseal osteotomy)with 18 cases,and the ulnar shaft osteotomy group(using plate for internal fixation of ulnar shaft osteotomy)with 16 cases.The surgical time,bleeding volume,fracture healing time,postoperative ulnar variation,and fracture nonunion rate between the two groups were recorded and compared.The modified Mayo wrist joint score,visual analogue scale(VAS),and upper limb function evaluation scale(DASH)were used to evaluate the efficacy of two osteotomy internal fixation methods.Results There was no statistically significant difference in preoperative general information between the metaphyseal osteotomy group and the ulnar shaft osteotomy group(P＞0.05),indicating comparability.All postoperative patients were followed up.The surgical time of the metaphyseal osteotomy group was(36.36±6.53)minutes,the bleeding volume was(13.35±5.89)ml,the follow-up time was(13.05±1.06)months,the fracture healing time was(9.45± 1.56)weeks,the postoperative ulnar variation value was(-1.8±0.5)mm,and the incidence of fracture nonunion was 0.The modified Mayo wrist joint score,VAS,and DASH scores were(85.6±4.30),(1.7± 1.3),and(25.0±17.0),respectively.The surgical time of the ulnar shaft osteotomy group was(87.35± 5.26)minutes,the bleeding volume was(35.25±4.36)ml,and the follow-up time was(14.05±1.33)months.The average fracture healing time was(12.55±2.34)weeks,and the postoperative ulnar variation value was(-2.2±0.4)mm.The incidence of fracture nonunion was 6.25％(1 patient had fracture nonunion,1/16).The modified Mayo wrist joint score,VAS,and DASH score were(81.3±5.5)points,(1.8±1.2)points,and(24.0±19.0)points,respectively.Two types of osteotomy internal fixation methods were compared.There were significant differences between the two groups in terms of surgical time,bleeding volume,fracture healing time,and the incidence of fracture nonunion,with statistical significance(P＜0.05).There were no significant differences in follow-up time,postoperative ulnar variation,Mayo score,VAS,and DASH score,and the differences were not statistically significant(P＞0.05).Conclusion As two methods to treat the ulnocarpal impaction syndrome,ulnar head metaphseal shortening osteotomy by hollow nail internal fixation is superior to ulnar shaft shortening osteotomy by plate internal fixation in terms of operation time,bleeding volume,bone healing time,fracture nonunion rate,which is worthy of recommendation and application.In terms of wrist joint function score recovery,both can achieve satisfactory therapeutic effects.
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