创伤性桡尺远侧关节背侧半脱位的治疗  

Treatment of tramnatic dorsal subluxafion of the distal radioulnar joint

作　　者：李岩峰[1] 蔡培华[1] 陆叶[1] 詹玉林[1] 范存义[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,201306

出　　处：《中华手外科杂志》2015年第5期362-364,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨创伤性桡尺远侧关节（distalradioulnarjoint，DRUJ）背侧半脱位的治疗方法。方法2010年8月至2014年6月，我们共收治28例不合并骨折的创伤性DRUJ背侧半脱位的患者。首先行保守治疗，前臂旋后位复位，然后屈肘90°位长臂石膏托固定6周，拆石膏后2个月内症状无明显缓解者认为无效。对无效者行桡尺韧带背侧浅部纤维加强术，术后旋后位长臂石膏托固定4周，然后改为短臂石膏托固定4周。结果术后随访时间为7个月至4．2年，平均2．5年。采用改良Mayo评分来评价腕关节功能。病程3周以内的14例患者保守治疗有效率为85．7％，病程3周以上的14例患者有效率为28．6％。对12例保守治疗失败者进行手术治疗，术后总体有效率为83．3％。结论创伤性DRUJ背侧半脱位早期诊断、早期治疗十分重要。病程超过3周保守治疗效果欠佳，对于保守治疗无效的DRUJ背侧半脱位患者取部分尺侧腕屈肌腱加强桡尺韧带背侧浅部纤维效果可靠。Objective To explore a treatment protocol for acute and chronic traumatic dorsal subluxation of distal radioulnar joint （DRUJ） and report the preliminary clinical results. Methods From August 2010 to June 2014, 28 patients with traumatic DRUJ dorsal subluxation and without fractures were included in our standardized treatment protocol. First, a course of conservative treatment was applied to immobilize the affected limb at forearm supination and 90°elbow flexion with an above elbow plaster for 6 weeks after manual reduction of the DRUJ. Patients with no symptom relief in 2 months after piaster removal were regarded as non-responsive and were subject to surgical reinforcement of dorsal radioulnar ligament. The flexor carpi ulnaris tendon was split in the middle. The radial haft was transversely divided 5 to 7 cm proximal to the pisiform bone, tunneled through the ulnar head in a volar-ulnar oblique to dorsal-radial direction, and then fixed over dorsal-ulnar side of the radius with 2 anchors. The extremity was then immobilized in an above elbow plaster with forearm in supination position for 4 weeks, followed by a short arm cast for another 4 weeks. Results The average follow-up time for all 28 patients was 2.5 years （range, 7 months to 4.2 years）. A functional evaluation was performed with modified Mayo wrist scoring system. The effective rate of conservative treatment was 85.7% for the 14 cases with less than 3 week post-injury interval and 28.6% for the 14 cases with longer than 3 week post-injury interval. The effective rate of 12 cases that underwent surgical treatment was 83.3 %. Conclusion Early diagnosis and early treatment for traumatic DRUJ dorsal subluxation is very important. Conservative treatment is less effective in cases of subluxation older than 3 weeks. For cases non-responsive to conservative treatment, surgical reinforeement of the dorsal superficial fibers of the radioulnar ligament with a tendon slip from flexor carpi ulnaris is a reliable solution.

关 键 词：腕关节 创伤性 桡尺远侧关节 半脱位 

分 类 号：R684.7[医药卫生—骨科学]