Zhu Andy F, Burns Geoffrey, Siljander Breana, Waljee Jennifer F, Ozer Kagan
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.
Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan.
J Wrist Surg. 2018 Nov;7(5):404-408. doi: 10.1055/s-0038-1666977. Epub 2018 Jul 9.
The triangular fibrocartilage complex (TFCC) provides stability to the wrist and disruption of this complex can result in axial instability which can lead to ulnocarpal abutment. This article determines the individual contributions of the volar radioulnar ligament (VRUL), dorsal radioulnar ligament (DRUL), and foveal attachment of the TFCC to longitudinal stability of the forearm under axial load. Eighteen cadaveric specimens were randomly assigned into three groups representing the component of the TFCC to be initially transected: VRUL, DRUL, and foveal attachment. Prior to transection, posterioranterior radiographs of the wrist were obtained at 0, 44.5, and 90 N of axial load. Serial transection of the TFCC components were performed with radiographs obtained at each of the aforementioned loads. Ulnar variance was assessed with two-way repeated measures analysis of variance and paired -tests. Transection of the foveal attachment demonstrated a significant change in ulnar variance of 1.5 and 0.6 mm under 45 and 90 N of load, respectively. At 0 N of load, there was no significant change in ulnar variance between an intact wrist and a wrist with all three ligaments transected; however, a significant change in ulnar variance, 1.0 mm, was observed under 90 N of load. The foveal attachment of the TFCC provides the largest contribution to axial stability. The TFCC provides axial stability to the wrist and disruption of the TFCC may result in change in ulnar variance observed on an axial loaded wrist radiograph.
三角纤维软骨复合体（TFCC）为腕关节提供稳定性，该复合体的损伤可导致轴向不稳定，进而导致尺腕撞击。本文确定了掌侧桡尺韧带（VRUL）、背侧桡尺韧带（DRUL）和TFCC的中央凹附着点在前臂轴向负荷下对纵向稳定性的各自贡献。18个尸体标本被随机分为三组，分别代表最初要横断的TFCC组成部分：VRUL、DRUL和中央凹附着点。在横断之前，在0、44.5和90N的轴向负荷下拍摄腕关节的前后位X线片。对TFCC各组成部分进行连续横断，并在上述每个负荷下拍摄X线片。采用双向重复测量方差分析和配对t检验评估尺骨变异。横断中央凹附着点后，在45N和90N负荷下，尺骨变异分别有1.5mm和0.6mm的显著变化。在0N负荷下，完整腕关节与三条韧带均横断的腕关节之间的尺骨变异无显著变化；然而，在90N负荷下，观察到尺骨变异有1.0mm的显著变化。TFCC的中央凹附着点对轴向稳定性的贡献最大。TFCC为腕关节提供轴向稳定性，TFCC的损伤可能导致在轴向负荷下的腕关节X线片上观察到尺骨变异的改变。
