Bain Gregory I, Eng Kevin, Lee Yu Chao, Mcguire Duncan, Zumstein Matthias
Department of Orthopaedic Surgery, Flinders University of South Australia, South Australia, Australia.
Barwon Orthopaedic Research Unit, Geelong University Hospital. Geelong, Victoria, Australia.
J Wrist Surg. 2015 Feb;4(1):9-14. doi: 10.1055/s-0034-1399756.
Background A triangular fibrocartilage complex (TFCC) injury can produce distal radioulnar joint (DRUJ) instability. If the foveal attachment is avulsed, it translates distally. The footprint is separated from its origin and will become covered in synovitis, preventing healing. The authors describe a surgical technique for the treatment of instability of the DRUJ due to chronic foveal detachment of the TFCC. Technique The procedure utilizes a loop of autologous palmaris longus tendon graft passed through the ulnar aspect of the TFCC and through an osseous tunnel in the distal ulna to reconstruct the fovel attachment. Patients and Methods We report on nine patients with a mean age of 42. Median follow-up was 13 months. Results The median pain scores measured were reduced from 8 to 3 postoperatively, and all had a stable DRUJ. Conclusions This technique provides stability of the distal ulna to the radius and carpus, with potential for biologic healing through osseous integration. It is a robust, anatomically based reconstruction of the TFCC to the fovea that stabilizes the DRUJ and the ulnar-carpal sag.
三角纤维软骨复合体（TFCC）损伤可导致远侧尺桡关节（DRUJ）不稳定。如果中央凹附着处撕脱，其会向远侧移位。附着点与其起源分离，会被滑膜炎覆盖，从而阻碍愈合。作者描述了一种手术技术，用于治疗因TFCC中央凹慢性撕脱导致的DRUJ不稳定。
该手术采用自体掌长肌腱移植环，穿过TFCC的尺侧部分并通过尺骨远端的骨隧道，以重建中央凹附着。
我们报告了9例患者，平均年龄42岁。中位随访时间为13个月。
术后测得的中位疼痛评分从8分降至3分，且所有患者的DRUJ均稳定。
该技术可使尺骨远端与桡骨及腕骨保持稳定，有可能通过骨整合实现生物学愈合。这是一种基于解剖结构的、可靠的TFCC至中央凹的重建方法，可稳定DRUJ及尺腕关节矢状面。
