Gillis Joshua A, Soreide Endre, Khouri Joseph S, Kadar Assaf, Berger Richard A, Moran Steven L
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedic Surgery, Oslo University Hospital, Nydalen, Oslo, Norway.
J Wrist Surg. 2019 Aug;8(4):268-275. doi: 10.1055/s-0039-1685235. Epub 2019 Apr 22.
The objective of this article is to evaluate the outcomes and complication rate for Adams-Berger anatomic reconstruction of the distal radioulnar joint (DRUJ), in addition, to determine the role of sigmoid notch anatomy on failure. We conducted a retrospective chart review to evaluate adult patients that had undergone reconstruction of the DRUJ for instability with the Adams-Berger procedure between 1998 and 2015 within our institution with > 24 months follow-up. Charts were reviewed for patient demographics, mechanism of injury, outcome, and complications. Ninety-five wrists in 93 patients were included. Mean age at surgery was 37.3 years with 65.2 months follow-up. At the last follow-up, 90.8% had a stable DRUJ, 5.3% did not, and 3.4% had some laxity. Postoperatively, 75.9% described either no pain or mild pain. Grip strength increased while pronosupination decreased. Procedure success was 86.3%, as 12 patients underwent revision at 13.3 months postoperatively. Reconstructive failure was more common in females when an interference screw was utilized for tendon fixation. Age, timing of surgery, type of graft, sigmoid notch anatomy, and previous surgery did not affect revision or failure rate. Our findings demonstrate that Adams-Berger reconstruction of the DRUJ provides reliable long-term results with an overall success of 86% at > 5 years follow-up. This is a Level IV, therapeutic study.
本文的目的是评估尺桡远侧关节（DRUJ）Adams-Berger解剖重建的结果及并发症发生率，此外，确定乙状切迹解剖结构在失败中的作用。我们进行了一项回顾性图表审查，以评估1998年至2015年在我们机构内接受Adams-Berger手术重建DRUJ以治疗不稳定的成年患者，随访时间超过24个月。审查图表以获取患者人口统计学信息、损伤机制、结果和并发症情况。纳入了93例患者的95侧腕关节。手术时的平均年龄为37.3岁，随访时间为65.2个月。在最后一次随访时，90.8%的DRUJ稳定，5.3%不稳定，3.4%有一定程度的松弛。术后，75.9%的患者表示无疼痛或轻度疼痛。握力增加，而旋前旋后功能下降。手术成功率为86.3%，因为有12例患者在术后13.3个月接受了翻修手术。当使用干涉螺钉进行肌腱固定时，重建失败在女性中更常见。年龄、手术时机、移植物类型、乙状切迹解剖结构和既往手术均未影响翻修率或失败率。我们的研究结果表明，DRUJ的Adams-Berger重建提供了可靠的长期结果，在随访超过5年时总体成功率为86%。这是一项IV级治疗性研究。
