Review of ulna oblique line shortening osteotomy for the treatment of ulna impingement effect of early treatment, analysis of ulna impingement of carpal bone cystic change factors and shortening of the ulna oblique line outcome after bone cutting.
From July 2021 to December 2023, 22 patients with ulnar impaction syndrome were treated in the Department of Hand and Ankle Surgery, the First People's Hospital of Jining. All patients were treated with ulnar oblique shortening osteotomy. The ulnar variation, visual analogue scale (VAS) score and modified Mayo wrist score were compared before operation and at the last follow-up to evaluate the early clinical effect of the operation. Gender, age, hand, disease duration, ulnar positive variation, VAS score, modified Mayo wrist score and other factors were compared to analyze the possible factors of carpal bone cystic degeneration in patients with ulnar impaction syndrome. The prognosis of carpal bone cystic degeneration after osteotomy was analyzed by comparing preoperative and postoperative X-ray films.
(1) All the 22 patients were followed up 12-27 months, with an average of 20.4 months. At the last follow-up, all the osteotomy sites achieved bone healing. The ulnar variation was (3.15±1.38)mm before operation and (-1.56±1.38)mm at the last follow-up, with statistically significant difference (t=3.58, P < 0.05). The preoperative VAS score was 5.90±1.19 points, and the last follow-up VAS score was 1.27±0.94 points, the difference was statistically significant (t=29.92, P < 0.05). The modified Mayo wrist score increased from 62.3±8.70 preoperatively to 80.9±9.70 postoperatively (t = 9.83, P < 0.05), and the results were excellent in 7 cases, good in 8 cases, and fair in 7 cases. (2) Of the 22 patients, 9 patients (4 males and 5 females) had cystic changes of the carpi on the X-ray films before operation, all of which were unilateral lesions. 4 cases were left hand, right hand in 5 cases; The average age was 62 years, and the average disease duration was 15 months. Compared with patients without carpal bone cystic degeneration, carpal bone cystic degeneration was correlated with age (t=-4.34, P<0.05), but not with disease duration, gender, hand, preoperative ulnar positive variation, preoperative VAS score, preoperative modified Mayo wrist score (P>0.05). At the last follow-up, the cystic changes became smaller or disappeared in all patients.
Oblique shortening osteotomy of ulna can improve wrist pain and function in patients with ulnar impaction syndrome, and the treatment effect is satisfactory. The cystic degeneration of carpal bones in patients with ulnar impaction syndrome may be related to the age of the patients. The cystic degeneration of the carpal bone can be recovered to varying degrees after oblique shortening osteotomy of the ulna.
