Roux J-L
Institut montpelliérain de la Main, 25 rue Clémentville, Montpellier, France.
Chir Main. 2010 Dec;29 Suppl 1:S119-26. doi: 10.1016/j.main.2010.09.021. Epub 2010 Oct 16.
We described the island transfer of the DRUJ to reconstruct the radiocarpal joint when the radiocarpal and the mediocarpal joints are destroyed. The objective is to avoid wrist arthrodesis or prosthesis.
From 1993 to 1997, five patients were operated, five men, the average age was 55 years (36 to 67). The operated side was the dominant side one time. The joint destruction was secondary to: SLAC wrist (stage 3) in two cases, a failure of PRC in two cases and post-traumatic necrosis of the lunatum in one case.
One failure was resumed by total wrist arthrodesis at 1-year follow-up. Four patients were revised with 11 years follow-up (from nine to 13). Two patients presented a pain-free wrist, two patients complain of barometric pain or after heavy works. The average mobility was: extension 40°, flexion 25°, ulnar deviation 30°, radial deviation -3°, complete pronosupination. The strength was 65% of the opposite side. X-rays showed an important radiocarpal reshaping and ulnar sliding of the carpus.
The island transfer of the DRUJ was possible in every case. The discordance between clinical and radiological results can be explained by joint denervation. We stopped this procedure not to sacrifice any more the healthy DRUJ.
The island transfer of the DRUJ to reconstruct the radiocarpal joint is a solution to avoid total wrist arthrodesis or prosthesis if we accept the DRUJ sacrifice.
我们描述了在桡腕关节和腕中关节遭到破坏时，采用尺桡远侧关节（DRUJ）岛状转移术来重建桡腕关节。目的是避免腕关节融合术或假体植入。
1993年至1997年，对5例患者实施了手术，均为男性，平均年龄55岁（36至67岁）。手术侧为优势侧1次。关节破坏继发于：2例为舟月关节分离塌陷型腕关节（SLAC腕，3期），2例为舟月关节融合术失败，1例为月骨创伤后坏死。
1例患者在1年随访时因手术失败而改行全腕关节融合术。4例患者接受了翻修手术，随访11年（9至13年）。2例患者腕部无痛，2例患者主诉有气压性疼痛或繁重工作后疼痛。平均活动度为：背伸40°，掌屈25°，尺偏30°，桡偏-3°，旋前旋后功能正常。力量为对侧的65%。X线显示桡腕关节有明显重塑以及腕骨向尺侧移位。
在每种情况下，尺桡远侧关节岛状转移术都是可行的。临床和放射学结果不一致可通过关节去神经支配来解释。我们停止了该手术，以免再牺牲健康的尺桡远侧关节。
如果我们接受牺牲尺桡远侧关节，那么采用尺桡远侧关节岛状转移术来重建桡腕关节是避免全腕关节融合术或假体植入的一种解决办法。
