Douglas Keith C, Parks Brent G, Tsai Michael A, Meals Clifton G, Means Kenneth R
The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD; George Washington University Medical Center, Department of Orthopedics, Washington, DC.
The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD; George Washington University Medical Center, Department of Orthopedics, Washington, DC.
J Hand Surg Am. 2014 Jul;39(7):1274-9. doi: 10.1016/j.jhsa.2014.03.028. Epub 2014 May 13.
To test distal forearm stability after 3 surgical procedures for distal radioulnar joint (DRUJ) arthritis.
We tested 11 cadaver limbs with the DRUJ intact, after distal ulna-matched hemiresection, after Darrach distal ulna resection, and after unlinked total DRUJ arthroplasty. We evaluated distal forearm stability in neutral rotation, full pronation, and full supination in unweighted and 1-kg-weighted conditions. We measured dorsal/palmar translation and convergence/divergence of the distal radius relative to the ulna.
Under neutral rotation, whether weighted or unweighted, matched hemiresection and Darrach specimens demonstrated significant radioulnar convergence relative to intact specimens. Weighted and unweighted, DRUJ arthroplasty demonstrated similar radioulnar convergence to intact. Weighted and unweighted, only Darrach specimens showed significant radius-palmar translation compared with intact, hemiresected, and DRUJ arthroplasty. In pronation, no testing scenario, either weighted or unweighted, demonstrated statistically significant radioulnar convergence relative to intact state. In unweighted pronation, palmar translation of the radius was significantly different from the intact state for all surgical scenarios and the Darrach was significantly worse than the other procedures. In weighted pronation, palmar translation of the radius was significantly different from the intact state for all surgical scenarios and the matched hemiresection was significantly better than the other procedures. In supination, weighted and unweighted, Darrach specimens had significant radioulnar convergence relative to intact. Either weighted or unweighted, the hemiresection and arthroplasty groups demonstrated similar radioulnar convergence relative to intact. Unweighted, all scenarios demonstrated similar dorsal translation of the radius. Weighted, the Darrach group showed significant radius-dorsal translation relative to intact specimens.
For tested procedures, DRUJ arthroplasty overall was biomechanically superior to the other conditions except that we found greater stability in the hemiresected group in weighted pronation.
Knowledge of baseline biomechanical characteristics of DRUJ arthritis procedures will aid surgical decision-making and patient counseling.
测试针对下尺桡关节（DRUJ）关节炎的三种外科手术术后前臂远端的稳定性。
我们对11具尸体上肢进行了测试，测试状态包括下尺桡关节完整、尺骨远端匹配半切除术后、Darrach尺骨远端切除术后以及非连接式全下尺桡关节置换术后。我们在未负重和负重1千克的情况下，评估了前臂远端在中立旋转、完全旋前和完全旋后时的稳定性。我们测量了桡骨远端相对于尺骨的背侧/掌侧平移以及聚拢/分开情况。
在中立旋转状态下，无论是否负重，匹配半切除标本和Darrach标本相对于完整标本均表现出显著的尺桡骨聚拢。无论负重与否，下尺桡关节置换术表现出与完整状态相似的尺桡骨聚拢。无论负重与否，与完整、半切除和下尺桡关节置换术相比，只有Darrach标本显示出显著的桡骨向掌侧平移。在旋前状态下，无论负重与否，没有任何测试情况相对于完整状态显示出统计学上显著的尺桡骨聚拢。在未负重旋前时，对于所有手术情况，桡骨的掌侧平移与完整状态有显著差异，且Darrach手术的情况比其他手术更差。在负重旋前时，对于所有手术情况，桡骨的掌侧平移与完整状态有显著差异，且匹配半切除手术的情况比其他手术明显更好。在旋后状态下，无论负重与否，Darrach标本相对于完整标本有显著的尺桡骨聚拢。无论负重与否，半切除组和置换术组相对于完整标本表现出相似的尺桡骨聚拢。在未负重时，所有情况均表现出相似的桡骨背侧平移。在负重时，Darrach组相对于完整标本显示出显著的桡骨背侧平移。
对于所测试的手术，总体而言下尺桡关节置换术在生物力学上优于其他情况，不过我们发现在负重旋前时半切除组的稳定性更高。
了解下尺桡关节关节炎手术的基线生物力学特征将有助于手术决策和患者咨询。
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