Brink Peter R G, Hannemann Pascal F W
Department of Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
J Wrist Surg. 2015 Aug;4(3):221-8. doi: 10.1055/s-0035-1556856.
Background Chronic, dynamic bidirectional instability in the distal radioulnar joint (DRUJ) is diagnosed clinically, based on the patient's complaints and the finding of abnormal laxity in the vicinity of the distal ulna. In cases where malunion is ruled out or treated and there are no signs of osteoarthritis, stabilization of the DRUJ may offer relief. To this end, several different techniques have been investigated over the past 90 years. Materials and Methods In this article we outline the procedure for a new technique using a tendon graft to reinforce the distal edge of the interosseous membrane. Description of Technique A percutaneous technique is used to harvest the palmaris longus tendon and to create a tunnel, just proximal to the sigmoid notch, through the ulna and radius in an oblique direction. By overdrilling the radial cortex, the knotted tendon can be pulled through the radius and ulna and the knot blocked at the second radial cortex, creating a strong connection between the radius and ulna at the site of the distal oblique bundle (DOB). The tendon is fixed in the ulna with a small interference screw in full supination, preventing subluxation of the ulna out of the sigmoid notch during rotation. Results Fourteen patients were treated with this novel technique between 2011 and October 2013. The QuickDASH score at 25 months postoperatively (range 16-38 months) showed an improvement of 32 points. Similarly, an improvement of 33 points (67-34 months) was found on the PRWHE. Only one recurrence of chronic, dynamic bidirectional instability in the DRUJ was observed. Conclusion This simple percutaneous tenodesis technique between radius and ulna at the position of the distal edge of the interosseous membrane shows promise in terms of both restoring stability and relieving complaints related to chronic subluxation in the DRUJ.
桡尺远侧关节(DRUJ)的慢性、动态双向不稳定是根据患者的主诉以及尺骨远端附近异常松弛的表现进行临床诊断的。在排除或治疗骨不连且无骨关节炎迹象的情况下,DRUJ的稳定可能会缓解症状。为此,在过去90年中研究了几种不同的技术。
在本文中,我们概述了一种使用肌腱移植来加强骨间膜远端边缘的新技术的操作过程。
采用经皮技术获取掌长肌腱,并在尺骨茎突切迹近端以斜向穿过尺骨和桡骨创建一个隧道。通过扩大桡骨皮质钻孔,将打结的肌腱拉过桡骨和尺骨,并将结阻挡在第二桡骨皮质处,在远端斜束(DOB)部位在桡骨和尺骨之间形成牢固连接。在完全旋前位用一个小的加压螺钉将肌腱固定在尺骨上,防止尺骨在旋转过程中从尺骨茎突切迹半脱位。
2011年至2013年10月期间,14例患者接受了这项新技术治疗。术后25个月(范围为16 - 38个月)的QuickDASH评分提高了32分。同样,在PRWHE上发现提高了33分(67 - 34个月)。仅观察到1例DRUJ慢性、动态双向不稳定复发。
这种在骨间膜远端边缘位置在桡骨和尺骨之间进行的简单经皮腱固定术在恢复稳定性和缓解与DRUJ慢性半脱位相关的症状方面都显示出前景。