Modified QiangGuBao Decoction Combined With Ulnar Distraction Osteogenesis In The Treatment Of Forearm Shortening Deformities In Children With Metaphyseal Aclasis

PurposeTo evaluate the clinical efficacy of modified QiangGuBao decoction combined with ulnar distraction osteogenesis in the treatment of forearm shortening deformities in children with metaphyseal aclasis.MethodsWe reviewed 20 pediatric patients(20 forearms,14 males and 6 females)with forearm shortening deformities following metaphyseal aclasis treated with ulnar distraction osteogenesis at our hospital between January 2019 and December 2019,with an average age of 7.2±1.3 years(range,5-9)and an average BMI of 20.8±1.5(range,18.8-23.7).Diameter of osteotomy site,and the percentage of gained bony length related to preoperative ulnar length were measured and recorded.At the termination of distraction,10 patients(experimental group)were randomly treated with four-weeks modified QiangGuBao decoction and 10without(control group).The differences of X-ray Lane-Sandhu scores were compared between two groups at the distraction termination and the forth-week following distraction termination,respectively.Time to removal of external fixator and bony healing,and union index were compared between two groups.Pre-and postoperative relative ulnar shortening and carpal slip as well as the functional outcome according to the quick version of Disabilities of the Arm,Shoulder and Hand scores(quick DASH)were evaluated and compared.ResultsA total of 20 patients were followed up,with an average duration of 8.8±2.5 months(range,3-12).The age,BMI,diameter of osteotomy site and the percentage of gained bony length related to preoperative ulnar length were similar to those in control group(P>0.05).At the forth-week following the distraction termination,the X-ray Lane-Sandhu scores(3.3±0.8)in experimental group was significantly higher than that(2.5±0.7)in control group(P=0.032).The time to removal of external fixator(103.0±12.4 days)and bony healing(138.4±22.6 days)and union index(44.2±1.9 days/cm)in experimental group were significantly superior to those(117.8±13.4 days,160.3±19.5 days and 49.7±3.7 days/cm)in control group(P<0.05).At the final follow up,the relative ulnar shortening,carpal slip and quick DASH scores were(0.3±0.3)cm,(53.1±3.2)% and(38.5±5.0),respectively,which improved significantly when compared to preoperative(3.2±0.4)cm,(69.2±14.4)% and(41.7±3.9),respectively.ConclusionsModified QiangGuBao decoction can improve the bone formation of distraction site and reduce the duration of treatment.Ulnar distraction osteogenesis can correct the deformities of forearm shortening and ulnar-deviation of the wrist following metaphyseal aclasis and improve the function,with a satisfactory outcome.