Department of Orthopaedic and Traumatology, Purpan Teaching Hospital Center, place du Docteur-Baylac, 31059 Toulouse cedex, France.
Orthop Traumatol Surg Res. 2010 May;96(3):216-21. doi: 10.1016/j.otsr.2009.12.009. Epub 2010 Apr 20.
Distal radius fractures represent 20% of fractures in adults. Although good results are usually obtained with treatment, functional sequelae are not uncommon, with injury of the distal radio-ulnar joint (DRUJ) being the most frequent. Various treatments have been described to address these disorders. Distal ulna resection-stabilisation (DURS) is our technique of choice when preservation of the DRUJ is impossible.
Twenty patients operated between 1985 and 1996 were reviewed with minimum 6-year follow-up. Nine of them were men and 11 were women, with an average age 45 years. The initial trauma was a distal radius fracture in all cases. The main complaint was ulnar pain with no limitation of mobility in five patients, painful limitation of prono-supination in 14, and palmar subluxation of the ulna in one case. Radiographic evaluation and CT scan showed DRUJ incongruence in 14 patients with ulna head instability, and ulno-carpal abutment with degenerative changes at the DRUJ in six cases. In three patients, malunion of the distal radius was associated with degenerative DRUJ lesions.
The satisfaction rate was 95% at an average follow-up of 11 years (range 6.7 to 18.6 years). Pain scores decreased progressively from 2.2 to 0.5 post-operatively. Range of motion improved in supination from 37 degrees to 80 degrees , and in pronation from 66 degrees to 84 degrees . Improvements were 15 degrees in ulnar inclination, 9 degrees in radial inclination, 16 degrees in flexion, and 23 degrees in extension. Distal ulna palpation was not painful, and no instability was observed on movement. Wrist strength was equivalent to 80.8% of the healthy contra-lateral side. Radiographic results showed no anomaly of the resected ulna, no sign of abutment on the radius and no ulnar translation of the carpus at follow-up. Only one patient, who presented algoneurodystrophic syndrome after the initial trauma, had a recurrence after DURS.
DISCUSSION-CONCLUSION: DRUJ injuries are frequent in the context of wrist trauma. If not well-treated, they could lead to significant functional sequelae of the wrist. Radiographic evaluation should clarify the status of the DRUJ to choose between conservative or radical surgical treatment. If the DRUJ surfaces are preserved, conservative treatment, which consists of correcting the distal radius malunion and stabilising or shortening the ulna, is the treatment of choice. When the DRUJ surfaces are injured, DURS is our treatment of choice. This approach presents a low complication rate and more than 90% of satisfactory results, often with a pain-free wrist, functional range of motion and good strength. However, a rigorous technique, with limited ulna head resection, dorsal capsuloplasty, reconstruction of the extensor retinaculum and dorsal placement of the extensor carpi ulnaris tendon, is a prerequisite for success.
Level IV retrospective therapeutic study.
桡骨远端骨折占成人骨折的 20%。尽管治疗通常能取得良好的效果，但功能后遗症并不少见，其中最常见的是桡尺远侧关节（DRUJ）损伤。已经描述了各种治疗方法来解决这些疾病。当无法保留 DRUJ 时，我们选择进行尺骨远端切除稳定术（DURS）。
1985 年至 1996 年间共对 20 名患者进行了手术，随访时间至少为 6 年。其中 9 名男性，11 名女性，平均年龄 45 岁。最初的创伤均为桡骨远端骨折。主要症状为 5 名患者出现尺侧疼痛，无活动受限，14 名患者出现疼痛性旋前-旋后受限，1 名患者出现尺骨掌侧半脱位。影像学评估和 CT 扫描显示 14 例患者存在 DRUJ 不吻合，尺骨头不稳定，6 例患者存在尺桡骨背侧骨突伴 DRUJ 退行性改变。在 3 名患者中，桡骨远端愈合不良与 DRUJ 退行性病变有关。
平均随访 11 年（6.7 至 18.6 年）后，患者的满意度为 95%。术后疼痛评分从 2.2 分逐渐降至 0.5 分。旋后运动范围从 37°改善至 80°，旋前运动范围从 66°改善至 84°。尺偏角改善 15°，桡偏角改善 9°，屈曲改善 16°，伸展改善 23°。尺骨远端触诊无疼痛，活动时无不稳定。腕部力量相当于健侧的 80.8%。随访时，切除的尺骨无异常，桡骨无骨突，腕骨无尺侧移位。只有 1 名患者在初次创伤后出现神经源性肌萎缩综合征，在 DURS 后复发。
讨论-结论：DRUJ 损伤在腕部创伤中很常见。如果治疗不当，可能会导致腕部严重的功能后遗症。影像学评估应明确 DRUJ 的状况，以便在保守治疗或激进手术治疗之间做出选择。如果 DRUJ 表面得到保留，可选择保守治疗，包括纠正桡骨远端愈合不良和稳定或缩短尺骨。当 DRUJ 表面受损时，我们首选 DURS。这种方法的并发症发生率较低，超过 90%的患者满意度高，常伴有无痛、功能活动范围和良好的力量。然而，严格的技术，包括有限的尺骨远端切除、背侧囊切开术、伸肌支持带重建和尺侧伸腕肌腱背侧放置，是成功的前提。
IV 级回顾性治疗研究。
