Krimmer Hermann, Unglaub Frank, Langer Martin F, Spies Christian K
Department of Hand Surgery, St. Elisabeth Hospital, Elisabethenstr. 19, 88212, Ravensburg, Germany.
Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany.
Arch Orthop Trauma Surg. 2016 Jan;136(1):143-8. doi: 10.1007/s00402-015-2363-y. Epub 2015 Nov 23.
The decompression of the distal radioulnar joint (DRUJ) is performed by ulnar translation of the radial shaft proximal to the sigmoid notch, i.e. detensioning of the distal part of the interosseous membrane (DIOM) while containment of the DRUJ is achieved by closed wedge osteotomy of the radius. The osteotomy shortens the radius which entails detensioning of the triangular fibrocartilage complex (TFCC).
Facilitating the modified Henry approach to the distal palmar radius a radial based wedge osteotomy is applied. The proximal osteotomy is proximal to the ulnar head and distal osteotomy is proximal to the sigmoid notch to prevent iatrogenic impingement. Ulnar translation of the radial shaft is performed to loosen the DIOM. The closed wedge osteotomy reduces radial inclination which will foster containment of the DRUJ.
Distal radial decompression osteotomy of the DRUJ preserves DRUJ function while relieving painful impingement. Further surgical interventions are not compromised in case of failure.
桡尺远侧关节（DRUJ）减压通过在乙状切迹近端对桡骨干进行尺侧移位来实现，即松解骨间膜远端部分（DIOM），而通过桡骨闭合楔形截骨术实现对DRUJ的包容。截骨术缩短桡骨，这必然会松解三角纤维软骨复合体（TFCC）。
采用改良的Henry入路至桡骨远端掌侧，应用以桡骨为基底的楔形截骨术。近端截骨位于尺骨头近端，远端截骨位于乙状切迹近端，以防止医源性撞击。对桡骨干进行尺侧移位以松解DIOM。闭合楔形截骨术减小桡骨倾斜度，这将有助于包容DRUJ。
DRUJ的桡骨远端减压截骨术在缓解疼痛性撞击的同时保留DRUJ功能。若手术失败，不会影响进一步的手术干预。
