Clinilcl Analysis Congenital Radioulnar Synostonsis In 16 Children

Objective:To analyze the clinical effect of rotary osteotomy of middle and upper segment of ulnar radius in the treatment of Congenital Radioulnar Synostonsis,and to summarize the experience of diagnosis and treatment of Congenital Radioulnar Synostonsis.Methods:The clinical data of 16 cases(19 sides)with Congenital Radioulnar Synostonsis admitted to the affiliated hospital of Zunyi Medical University from January2011 to June 2019 were retrospectively analyzed,including 10 males(12 sides)and 6females(7 sides),with an age ranging from 3.0 to 9.0 years old and a median age of 5.0years old.Clinical manifestations:the affected limb is in the prepronation position and cannot be rotated back,a small number of children may present abnormal appearance and bilateral upper limb asymmetry and other symptoms,seriously affecting the life and learning of children,the positive and lateral ulnar and radial X-ray of the affected limb shows different degrees of ulnar and radial fusion,and partial deformation of the small head of the radius.All patients according to Cleary classification can be divided into:I type(1 side):The ulnar and radial bones are slightly fused,the radial head is normally located.II type(2 side):The ulnar and radial bones were fused,the radial head was not dislocated.III type(15):The ulnar and radial bones were obviously fused,the posterior dislocation of the radial head was accompanied by dysplasia.IV type(1):The ulnar and radial bones are obviously fused,one end is significantly shortened,The radial head is dislocated forward and looks like a mushroom.After internal fixation of ulnar and radial fractures,malunion,soft tissue contracture around ulnar and radial fractures and other related factors were excluded.Sixteen cases(16 sides)received surgical treatment,all of which were subjected to rotation and internal fixation of the middle and upper part of the ulnar and radial bone,and were rotated to functional position in stage I.After surgery,theforearm was fixed at the position of 10° ~ 20° before rotation and the elbow flexion at 90°for 4-6 weeks with a long arm plaster bracket.The treatment effect was evaluated by comparing the score difference of the classification system of the functional range of forearm rotation of Failla before and after surgery and measuring the degree of forearm rotation at 90° of elbow flexion.Results:Sixteen cases(16 sides)were treated with surgery,and postoperativefollow-up was conducted for 18 to 36 months,with no effect on elbow flexion and extension.They could basically complete daily life such as book turning,key turning and tableware lifting,and their quality of life was significantly improved,with faila scores before and after operation were statiscally siginificant(t=24.95,P < 0.01).The preoperative deformity Angle of the affected limb was 70°±20°,and the postoperative deformity Angle was30°±10°.According to the evaluation standard of wei xinjun,9 cases were excellent,7 cases were good,and 0 case were poor.No complications such as compartment syndrome,nonunion of bone and osteomyelitis occurred.Conclusion:1.Rotary osteotomy of the middle and upper segment of ulnar radius is one of the ideal methods for the treatment of Congenital Radioulnar Synostonsis with simple operation and few complications.2.Cleary typing combined with Failla score,at the same time,according to the degree of deformity on the imaging,and reference to the rotation of the affected limb to determine whether surgical treatment,more conducive to the determination of Congenital Radioulnar Synostonsis of the surgical pointer.