Greenberg Jeffrey A, Werner Frederick W, Smith Jared M
Indiana Hand to Shoulder Center, Indianapolis, Indiana; SUNY Upstate Medical University, Syracuse, New York.
J Hand Surg Am. 2013 Oct;38(10):1919-24. doi: 10.1016/j.jhsa.2013.06.038. Epub 2013 Aug 24.
To investigate the effect of a closing wedge osteotomy at the distal ulnar metaphysis on unloading the ulnar side of the wrist.
Seven fresh frozen cadaver arms mounted in a wrist simulator were used for the analysis. A 6-degrees-of-freedom load cell was mounted on the distal radius and another on the distal ulna. Radioulnar carpal joint forces and transverse distal radioulnar joint (DRUJ) load were measured at static wrist positions and during dynamic wrist motions before and after the distal metaphyseal ulnar shortening osteotomy (DMUSO) was performed.
At each static position, significant decreases in ulnar load were noted after DMUSO. In addition, mean and maximum loads decreased for each dynamic wrist motion. There were no statistically significant differences in transverse forces across the DRUJ after DMUSO.
This study showed that DMUSO is an effective way to decrease the load across the ulnocarpal joint. The geometry of the osteotomy and resultant change in the position of the ulnar head did not increase transverse joint reaction forces.
This technique is an alternative to open diaphyseal techniques or methods that damage the articular surface of the distal ulna. Clinical studies will be necessary to associate the biomechanical correction noted in this study with clinical symptom improvement.
探讨尺骨远端干骺端闭合楔形截骨术对减轻腕关节尺侧负荷的效果。
使用7个安装在腕关节模拟器上的新鲜冷冻尸体手臂进行分析。在桡骨远端安装一个六自由度测力传感器，在尺骨远端安装另一个。在进行尺骨远端干骺端缩短截骨术（DMUSO）之前和之后，测量腕关节静态位置和动态运动过程中的桡尺腕关节力和远端桡尺关节（DRUJ）横向负荷。
在每个静态位置，DMUSO后尺侧负荷均显著降低。此外，每个腕关节动态运动的平均负荷和最大负荷均降低。DMUSO后DRUJ的横向力无统计学显著差异。
本研究表明，DMUSO是减轻尺腕关节负荷的有效方法。截骨的几何形状和尺骨头位置的相应变化并未增加关节横向反应力。
该技术是开放性骨干技术或损伤尺骨远端关节面方法的替代方法。需要进行临床研究，以将本研究中指出的生物力学矫正与临床症状改善联系起来。
