Wnorowski D C, Palmer A K, Werner F W, Fortino M D
Central New York Orthopedic Center, Syracuse 13214.
Arthroscopy. 1992;8(2):204-12. doi: 10.1016/0749-8063(92)90038-d.
The ulnar impaction syndrome is a common clinical entity that is most often associated with positive ulnar variance and is characterized by triangular fibrocartilage complex (TFCC), lunate, and/or distal ulnar pathology. Traditional treatment for symptomatic ulnar impaction syndrome has been conservative; however, in cases refractory to nonoperative management, formal ulnar shortening has been successful in long-term clinical series. Recently, arthroscopic ulnar shortening, the "arthroscopic wafer procedure" (AWP) (debridement of the perforated TFCC margins and limited ulnar head resection using a motorized burr) has become an option to treat this clinical syndrome. In an attempt to evaluate the biomechanical efficacy of the AWP, an experimental study was undertaken using nine ulnar positive cadaver forearms. Each specimen was evaluated biomechanically using axial load cells and pressure-sensitive film to evaluate the effect of serial resection of the TFCC and distal ulna on axial load and ulnar carpal pressures. The results of this experimental study revealed a statistically significant unloading of the ulnar aspect of the wrist after excision of the centrum of the TFCC and resection of the radial two-thirds width of the ulnar head, to a depth of subchondral bone resection. Furthermore, additional bony resection tended to correlate favorably with the stage of TFCC pathology noted, i.e., the more advanced the stage, the more resection necessary to unload the ulnar aspect of the wrist. Based on this biomechanical study, a limited clinical series has been initiated with early favorable results. The AWP biomechanically unloads the ulnar carpal complex, and therefore has a theoretical potential of relieving the symptoms of the ulnar impaction syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
尺骨撞击综合征是一种常见的临床病症，通常与尺骨正向变异相关，其特征为三角纤维软骨复合体（TFCC）、月骨和/或尺骨远端病变。有症状的尺骨撞击综合征的传统治疗方法一直是保守治疗；然而，在非手术治疗无效的病例中，正式的尺骨短缩术在长期临床系列研究中取得了成功。最近，关节镜下尺骨短缩术，即“关节镜下骨片切除术”（AWP）（使用电动磨钻清理穿孔的TFCC边缘并有限切除尺骨头）已成为治疗该临床综合征的一种选择。为了评估AWP的生物力学效果，使用九个尺骨正向的尸体前臂进行了一项实验研究。每个标本使用轴向载荷传感器和压敏膜进行生物力学评估，以评估TFCC和尺骨远端连续切除对轴向载荷和尺腕压力的影响。该实验研究结果显示，在切除TFCC中心并切除尺骨头部桡侧三分之二宽度至软骨下骨切除深度后，腕关节尺侧出现统计学上显著的负荷减轻。此外，额外的骨切除往往与所观察到的TFCC病变阶段呈良好相关性，即阶段越 advanced，为减轻腕关节尺侧负荷所需的切除量就越大。基于这项生物力学研究，已启动了一个有限的临床系列研究，早期结果良好。AWP在生物力学上减轻了尺腕复合体的负荷，因此在理论上有缓解尺骨撞击综合征症状的潜力。（摘要截断于250字） （注：“advanced”这里结合语境可能是“严重、进展到更严重阶段”等意思，因未明确医学专业对应准确表述，暂保留英文）
