目的 探讨尺骨撞击综合征患者术后桡尺远侧关节解剖对应性改变对临床疗效及功能康复的影响，为优化手术策略提供临床依据。 方法 回顾性分析2023年7月至2025年4月本院手外科采用尺骨短缩截骨术治疗的10例尺骨撞击综合征患者围手术期资料，基于术前术后影像学评估桡尺远侧关节Tolat分型变化，记录手术时间、术后疼痛时间、重返工作时间及功能指标（疼痛评分、腕关节活动度、握力、QuickDASH评分及改良Mayo腕关节评分）。 结果 资料显示随访时间为3~18个月，术后桡尺远侧关节分型分布发生偏移，由Tolat 3型向Tolat 1型、Tolat 2型转化；术后疼痛评分、Quick DASH评分、屈伸活动度、握力及改良Mayo腕关节评分均较术前改善（P<0.05）。桡尺远侧关节变异度大者较变异度小者术后疼痛持续时间延长（P<0.05）。 结论 尺骨短缩截骨术后疼痛与桡尺远侧关节对应状态改变密切相关，维持桡尺远侧关节解剖对应性或可实现更快功能恢复。在加速康复理念下，维持桡尺远侧关节解剖对应性对患者临床疗效有积极作用。
Abstract
Objective To explore the impact of the postoperative anatomical changes in distal radioulnar joint (DRUJ) congruence in patients with ulnar impaction syndrome on clinical efficacy and functional recovery, and to provide clinical evidence for optimizing surgical strategies. Methods A retrospective analysis was conducted on the perioperative data of 10 patients who underwent ulnar shortening osteotomy in the hand surgery department of our hospital between July 2023 and March 2025. Based on the preoperative and postoperative imaging evaluations of the distal radioulnar joint Tolat classification changes, the operative time, postoperative pain duration, return-to-work time, and functional outcomes (pain score, wrist joint range of motion, grip strength, QuickDASH score, and modified Mayo Wrist Score) were recorded. Results The follow-up period was 3 to18 months. After operation, the distribution of DRUJ classification shifted, with transitions from Tolat type 3 to Tolat types 1 and Tolat type 2. The postoperative pain scores, Quick DASH scores, range of flexion and extension, grip strength, and modified Mayo Wrist Scores all improved compared to the preoperative values (P<0.05). Those with greater variability in the distal radioulnar joint had a longer duration of postoperative pain compared to those with less variability(P<0.05). Conclusions Postoperative pain after ulnar shortening osteotomy is closely associated with alterations in the congruence state of the distal radioulnar joint. Maintaining the anatomical congruence of the DRUJ may facilitate faster functional recovery. Under the concept of enhanced recovery after surgery, preservation of DRUJ congruence can positively influence clinical outcomes.
关键词
尺骨撞击综合征 /
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桡尺远侧关节 /
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尺骨短缩截骨术 /
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快速康复
Key words
Ulnar impaction syndrome /
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Distal radioulnar joint /
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Ulnar shortening osteotomy /
Enhanced recovery after surgery (ERAS)
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参考文献
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基金
深圳市宝安区医学会医疗卫生科研项目（BAYXH2024010）；深圳市“医疗卫生三名工程”项目资助（SZZYSM202311017）
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