关节外固定术治疗慢性下尺桡关节背侧不稳定  

ARTICULAR EXTERNAL FIXATION FOR CHRONIC DORSAL INSTABILITY OF DISTAL RADIOULNAR JOINT

作　　者：姜宗圆[1] 夏江[1] 马涛[1] 徐磊[1] 胡才智 王寅泽 胡斌[1] 

机构地区：[1]皖南医学院弋矶山医院手足外科,安徽芜湖241001

出　　处：《中国修复重建外科杂志》2014年第2期209-212,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨尺侧伸腕肌腱关节外捆绑法结合锚钉技术治疗下尺桡关节（distalradioulnarioint，DRuJ）慢性背侧不稳定的疗效。方法2011年7月-2012年12月，采用尺侧伸腕肌腱关节外捆绑法结合锚钉技术治疗慢性单纯DRUJ背侧不稳定患者6例。其中男1例，女5例；年龄22～35岁，平均27-3岁。患者均有不同程度腕部外伤史；病程6个月～15年，平均4．8年。术后摄X线片了解锚钉有无松动；通过“琴键征”试验和前臂旋转试验判断DRUJ功能恢复情况；记录并发症；末次随访时记录患肢的握力、关节活动度和疼痛视觉模拟评分（VAS），关节功能以前臂、肩、手功能障碍评分（DASH）评估，并与术前比较。结果术后患者切口均I期愈合，未出现术中尺骨颈骨折及术后感染等并发症。6例均获随访，随访时间6～24个月，平均13．7个月。患者的DRUJ均重获稳定，术后3、6个月常规复查x线片示DRUJ关节间隙增宽，尺骨头脱位均明显改善，患者腕关节“琴键征”试验和前臂旋转试验均呈阴性。末次随访时，患肢握力、DASH评分、VAS评分及腕关节背伸、掌屈、旋前、旋后活动度均较术前显著改善，差异均有统计学意义（P〈0．05）。结论采用尺侧伸腕肌腱关节外捆绑法结合锚钉技术治疗DRUJ慢性背侧不稳定在达到稳定固定的同时，很好地保护了三角纤维软骨复合体，且操作简便，是一种较好方法。Objective To discuss the clinical result of extrinsic radioulnar tether combined with anchoring nail fixation for treating chronic dorsal instability of the distal radioulnar joint （DRUJ）. Methods Between July 2011 and December 2012, 6 patients with chronic dorsal instability of the DRUJ were treated with extrinsic radioulnar tether combined with anchoring nail fixation. There were 1 male and 5 females with the average age of 27.3 years （range, 22-35 years）. All of 6 patients had a wrist trauma history. The average disease duration was 4.8 years （range, 6 months to 15 years）. Radiographs were taken postoperatively to observe the anchoring nail loosening. The stress test and forearm rotation test were used to evaluate the function of DRUJ. The complications, the grip power, range of motion, and visual analogue scale （VAS） scores were recorded at last follow-up. And the joint function was evaluated by disability of arm, shoulder, and hand （DASH） score. Results Primary healing of incision was obtained in all cases, without any complications such as infection and ulnar neck fracture. All 6 patients were followed up 6-24 months （mean, 13.7 months）. Stability was achieved in all patients. Radiographs showed that the joint space was widened and dislocation of the ulnar head was improved at 3 and 6 months after operation. The results of the stress test and forearm rotation test were negative. At last follow-up, the grip power, DASH score, VAS score, and range of motion of the wrist were significantly improved when compared with preoperative ones （P 〈 0.05）. Conclusion Extrinsic radioulnar tether combined with anchoring nail fixation is an easy method of surgical revision to treat chronic dorsal instability of DRUJ, which can maintain the stability and protect the blood supply of triangular fibrocartilage complex.

关 键 词：下尺桡关节 韧带重建 肌腱固定 关节外固定术 

分 类 号：R687.3[医药卫生—骨科学]