Marès O
Service de chirurgie orthopédique Pr-Kouyoumdjian, CHU de Nîmes, avenue du Pr-Debré, 30000 Nîmes, France.
Hand Surg Rehabil. 2017 Oct;36(5):305-313. doi: 10.1016/j.hansur.2017.08.001. Epub 2017 Aug 31.
Distal radioulnar joint (DRUJ) instability is a rare but disabling problem. Surgical treatment remains a challenge. The advent of arthroscopic techniques has helped to rebuild the triangular fibrocartilaginous complex (TFCC), especially its deep part. However, isolated TFCC damage is not responsible for instability. Its repair is sometimes not sufficient to restore DRUJ stability, or the chronicity of the injury prevents its direct repair. Open surgical procedures still have a role in these cases. They require a detailed knowledge of the various stabilizers of the DRUJ. Passive and active stabilizers other than the TFCC include the bones, joint capsule, oblique distal bundle of the interosseous membrane and the extensor carpi ulnaris. The objective of this review was to analyze current anatomical and biomechanical data on DRUJ stability. Different arthroscopic and open repair techniques for these structures will be reviewed. Lastly, a decision tree will be presented that can be used to better plan the management of this complex entity, because most of these injuries often occur in combination in RUD instability cases.
桡尺远侧关节（DRUJ）不稳定是一个罕见但致残的问题。手术治疗仍然是一项挑战。关节镜技术的出现有助于重建三角纤维软骨复合体（TFCC），尤其是其深部。然而，孤立的TFCC损伤并非导致不稳定的原因。其修复有时不足以恢复DRUJ的稳定性，或者损伤的慢性化阻碍了其直接修复。在这些情况下，开放手术仍有作用。它们需要对DRUJ的各种稳定结构有详细的了解。除了TFCC之外，被动和主动稳定结构还包括骨骼、关节囊、骨间膜远端斜束和尺侧腕伸肌。本综述的目的是分析目前关于DRUJ稳定性的解剖学和生物力学数据。将对这些结构的不同关节镜和开放修复技术进行综述。最后，将呈现一个决策树，可用于更好地规划对这个复杂病症的处理，因为在桡尺远侧关节不稳定病例中，这些损伤大多常常合并出现。
