Kopylov Philippe, Tägil Magnus
Hand and Upper Extremity Unit, Department of Orthopedics, Lund University Hospital, Lund, Sweden.
Tech Hand Up Extrem Surg. 2007 Mar;11(1):109-14. doi: 10.1097/bth.0b013e3180337dd9.
The resection of the ulnar head, as described by Darrach, has unfortunately become the standard of care despite the frequent problems of ulnar stump instability following this procedure. To offer better treatment to our patients, we have to appreciate the various roles and the importance of the ulnar head for the function of the distal radioulnar joint (DRUJ) in mechanically loaded forearm rotation. The ulnar head forms the load-bearing keystone of the DRUJ and the distal forearm, important for maintaining adequate tension within the radioulnar ligaments and the interosseous membrane. A DRUJ implant replacing the ulnar head should and has to be the fixed point and load-bearing part of the joint and will be exerted to large mechanical loads making a neutralization of these forces necessary. A partial resurfacing implant for the DRUJ can be used for primary procedures. The resection is minimal, and further, the attachments of the stabilizing ligaments, the triangular fibrocartilage complex in particular, are preserved with a maintained anatomy and stability. For revision and salvage procedure, a modular ulnar head can be used, which restores the ulnar head offset and stabilizes the ulnar stump, restoring a pain-free DRUJ. The modularity of these 2 implants addresses the majority of indications for prosthesis in the DRUJ.
尽管按照达拉赫（Darrach）描述的方法切除尺骨头后，尺骨残端不稳定问题频发，但不幸的是，这种方法已成为标准治疗手段。为了给患者提供更好的治疗，我们必须认识到尺骨头在机械负荷下前臂旋转时，对远侧桡尺关节（DRUJ）功能所起的各种作用及其重要性。尺骨头构成了远侧桡尺关节和前臂远端的承重关键部分，对于维持桡尺韧带和骨间膜内的适当张力很重要。替代尺骨头的远侧桡尺关节植入物应该且必须是关节的固定点和承重部分，并且会承受较大的机械负荷，因此需要中和这些力量。远侧桡尺关节的部分表面置换植入物可用于初次手术。切除范围最小，而且，稳定韧带（特别是三角纤维软骨复合体）的附着点得以保留，解剖结构和稳定性得以维持。对于翻修和挽救手术，可使用模块化尺骨头，它能恢复尺骨头的偏移并稳定尺骨残端，恢复无痛的远侧桡尺关节。这两种植入物的模块化解决了远侧桡尺关节假体的大部分适应症问题。
