Herbert Timothy J, van Schoonhoven Joerg
St Lukes Hospital Hand Unit, Sydney, New South Wales, Australia.
Tech Hand Up Extrem Surg. 2007 Mar;11(1):98-108. doi: 10.1097/bth.0b013e318033738a.
Recent years have seen an increasing awareness of the anatomical and biomechanical significance of the distal radioulnar joint (DRUJ). With this has come a more critical approach to surgical management of DRUJ disorders and a realization that all forms of "excision arthroplasty" can only restore forearm rotation at the expense of forearm stability. This, in turn, has led to renewed interest in prosthetic replacement of the ulnar head, a procedure that had previously fallen into disrepute because of material failures with early implants, in particular, the Swanson silicone ulnar head replacement. In response to these early failures, a new prosthesis was developed in the early 1990s, using materials designed to withstand the loads across the DRUJ associated with normal functional use of the upper limb. Released onto the market in 1995 (Herbert ulnar head prosthesis), clinical experience during the last 10 years has shown that this prosthesis is able to restore forearm function after ulnar head excision and that the materials (ceramic head and noncemented titanium stem), even with normal use of the limb, are showing no signs of failure in the medium to long term. As experience with the use of an ulnar head prosthesis grows, so does its acceptance as a viable and attractive alternative to more traditional operations, such as the Darrach and Sauve-Kapandji procedures. This article discusses the current indications and contraindications for ulnar head replacement and details the surgical procedure, rehabilitation, and likely outcomes.
近年来，人们对桡尺远侧关节（DRUJ）的解剖学和生物力学意义的认识日益加深。随之而来的是，对于DRUJ疾病的手术治疗采取了更为严谨的方法，并且认识到所有形式的“切除关节成形术”都只能以牺牲前臂稳定性为代价来恢复前臂旋转功能。这反过来又引发了人们对尺骨头假体置换术的新兴趣，该手术此前因早期植入物出现材料故障而声名狼藉，尤其是斯旺森硅胶尺骨头置换术。针对这些早期失败案例，20世纪90年代初研发出了一种新型假体，其使用的材料旨在承受与上肢正常功能使用相关的DRUJ上的负荷。该假体于1995年投放市场（赫伯特尺骨头假体），过去10年的临床经验表明，这种假体能够在切除尺骨头后恢复前臂功能，而且其材料（陶瓷头和非骨水泥钛柄）即使在肢体正常使用的情况下，从中长期来看也没有出现失败的迹象。随着使用尺骨头假体经验的积累，它作为一种比更传统手术（如达拉奇手术和索维 - 卡潘迪手术）更可行且有吸引力的替代方案，越来越被人们所接受。本文讨论了当前尺骨头置换的适应证和禁忌证，并详细介绍了手术过程、康复情况以及可能的结果。
