Papatheodorou Loukia K, Rubright James H, Kokkalis Zinon T, Sotereanos Dean G
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Wrist Surg. 2013 Feb;2(1):13-8. doi: 10.1055/s-0032-1333062.
The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate.
尺骨远端切除术（达拉赫手术）的主要并发症是桡尺撞击和不稳定。尽管已有关于达拉赫手术改良方法的报道，但仍有较高的失败率。人们已开发出多种手术技术来治疗这一难题，并减轻与疼痛性汇聚和撞击相关的症状。尚无技术显示出临床优势。最近，尺骨远端植入式关节成形术已被认可为治疗尺骨远端切除术失败的有症状患者的一种选择。然而，人们担心植入物的使用寿命，尤其是在年轻、活跃的成年人中。切除间置关节成形术依靠在桡骨远端和切除的尺骨远端之间置入跟腱同种异体移植物。虽然该技术不能恢复桡尺远侧关节的正常力学，但可防止桡骨向尺骨的疼痛性汇聚。跟腱同种异体移植物间置关节成形术是尺骨远端切除术失败后的一种安全且高效的替代方法，尤其适用于植入物或其他手术可能不合适的年轻、活跃患者。
