前臂纵向分离的研究进展  

Research advancements of longitudinal radioulnar dissociation

作　　者：赵宝成[1] 袁天祥[1] 马宝通[1] 

机构地区：[1]天津市天津医院创伤骨科二病区300211

出　　处：《中国矫形外科杂志》2014年第9期808-811,共4页Orthopedic Journal of China

摘　　要：前臂纵向分离(longitudinal radioulnar dissociation,LRUD)是指腕部受到轴向暴力,造成桡骨头/颈骨折或脱位合并骨间膜撕裂和下尺桡关节分离的复杂联合损伤,引起前臂纵向不稳定。生物力学研究表明在切除桡骨小头情况下,单纯重建骨间膜仅能减轻桡骨向近侧移位,而恢复LRUD前臂的纵向稳定性需要骨间膜重建与桡骨头金属假体置换联合。LRUD误诊和漏诊率高,MRI和B超是早期检查骨间膜损伤的有效方法。目前治疗强调修复LRUD的所有损伤结构而恢复前臂稳定性,即修复或重建桡骨头、矫正下尺桡关节,同时重建骨间膜。治疗成功与否取决于能否早期诊断。Longitudinal radioulnar dissociation （ LRUD ） can be considered as an complex injury of fracture or dislocation of the radial head/neck, the interosseous membrane tear and disruption of the distal radioulnar joint, resulting from an axial load to the forearm. Isolated reconstruction of interosseous membrane only reduce the proximal migration of the radius, rather than obtaining the same stiffness of interosseous membrane when the radial head sectioned. Combination of reconstruction of interosseous membrane and matellic prosthetic replacement of radial head is helpful for restoration of the forearm stability in LRUD. The materials common for reconstruction include ： semitendinous tendon, achilles tendon, palmar longns tendon, pronator teres, bone - patella tendon - bone, and synthetic graft. It＇ s a challenging problem of early diagnosis with highly unrecognized. MRI and ultrasound have demonstrated efficiency clinically for early detection of interosseous disruption. The advancement of surgical treatment is to aim at addressing all the injured structures involved in LRUD. Surgical treatment includes open reduction/internal fixation or prosthetic replacement of the radial head as well as repair of the disrupted triangular fibrocartilage complex, especially reconstruction of interosseous ligament, with leveling of distal radio - ulna joint. Successful treatment of LRUD is relied on early diagnosis.

关 键 词：前臂纵向分离 Essex—Lopresti损伤 骨间膜 治疗 

分 类 号：R687.3[医药卫生—骨科学]