Redeker J, Vogt P M
Klinik für Plastische, Hand- und Wiederherstellungschirurgie, St. Barbara Hospital, Katholisches Klinikum Duisburg, Deutschland.
Chirurg. 2011 Jan;82(1):85-93; quiz 94. doi: 10.1007/s00104-009-1867-9.
Carpal instability can be understood as a disturbed anatomical alignment between bones articulating in the carpus. This disturbed balance occurs either only dynamically (with movement) under the effect of physiological force or even statically at rest. The most common cause of carpal instability is wrist trauma with rupture of the stabilizing ligaments and adaptive misalignment following fractures of the radius or carpus. Carpal collapse plays a special role in this mechanism due to non-healed fracture of the scaphoid bone. In addition degenerative inflammatory alterations, such as chondrocalcinosis or gout, more rarely aseptic bone necrosis of the lunate or scaphoid bones or misalignment due to deposition (Madelung deformity) can lead to wrist instability. Under increased pressure the misaligned joint surfaces lead to bone arrosion with secondary arthritis of the wrist. In order to arrest or slow down this irreversible process, diagnosis must occur as early as possible. Many surgical methods have been thought out to regain stability ranging from direct reconstruction of the damaged ligaments, through ligament replacement to partial stiffening of the wrist joint.
腕关节不稳可理解为腕骨间关节的解剖排列紊乱。这种紊乱的平衡要么仅在生理力作用下动态地（随着运动）出现，要么甚至在静止时静态地出现。腕关节不稳最常见的原因是腕部创伤，伴有稳定韧带断裂以及桡骨或腕骨骨折后的适应性错位。由于舟状骨骨折不愈合，腕骨塌陷在这一机制中起特殊作用。此外，退行性炎症改变，如软骨钙质沉着症或痛风，更罕见的是月骨或舟状骨的无菌性骨坏死或因沉积导致的错位（马德隆畸形），都可能导致腕关节不稳。在压力增加的情况下，错位的关节面会导致骨质侵蚀，并继发腕关节关节炎。为了阻止或减缓这一不可逆过程，必须尽早进行诊断。人们已经想出了许多手术方法来恢复稳定性，从直接重建受损韧带，到韧带置换，再到腕关节部分僵硬固定。
