Wimalawansa Sunishka M, Lopez Rocio Rodriguez, de Lucas Fernando Garcia, De Smet Luc, Boin Michael A, Dorweiler Matthew, Degreef Ilse
1 Christine M. Kleinert Institute, Louisville, KY, USA.
2 Wright State University, Dayton, OH, USA.
Hand (N Y). 2017 Sep;12(5):476-483. doi: 10.1177/1558944716676251. Epub 2016 Oct 28.
Historically, failed conservative treatment for irreparably damaged distal radioulnar joints (DRUJs) is treated via distal ulnar resection or DRUJ fusion; complications include disabling painful convergence of the radius and ulnar stump during lifting Various treatments for radioulnar impingement include distal radioulnar Achilles tendon allograft interpositional arthroplasty. This technique does not adequately prevent radioulnar impingement and we explore an alternative treatment.
We report 7 adult patients who failed Achilles tendon interposition, subsequently treated with Aptis total DRUJ prostheses (mean follow-up, 26 months; range, 7-40).
Revision to Aptis prosthesis produced clinically stable DRUJ, improved grip strength and painless lifting capabilities, high patient satisfaction, and no major complications. All returned to daily activities and even recreational sports.
Tendon lacks biomechanical features key to the shock-absorbing function of cartilage-features it cannot deliver when used to prevent radioulnar convergence. We report Aptis DRUJ prosthesis as an alternative to the tendon allograft technique.
从历史上看，对于无法修复的远侧桡尺关节（DRUJ），保守治疗失败后通过尺骨远端切除术或DRUJ融合术进行治疗；并发症包括在提举过程中桡骨和尺骨残端疼痛性融合，导致功能障碍。针对桡尺撞击的各种治疗方法包括远侧桡尺关节跟腱同种异体移植间置关节成形术。该技术不能充分预防桡尺撞击，我们探索了一种替代治疗方法。
我们报告了7例跟腱间置治疗失败的成年患者，随后采用Aptis全DRUJ假体进行治疗（平均随访26个月；范围7 - 40个月）。
改用Aptis假体后，DRUJ在临床上保持稳定，握力提高，提举时无痛，患者满意度高，且无重大并发症。所有患者均恢复了日常活动，甚至可以进行娱乐性运动。
肌腱缺乏软骨减震功能的关键生物力学特性，在用于预防桡尺融合时无法发挥这些特性。我们报告Aptis DRUJ假体可作为同种异体肌腱技术的替代方法。
