Low Sara L, Clippinger Benjamin B, Landfair Germanuel L, Criner-Woozley Katharine
Einstein Healthcare Network, Philadelphia, PA.
Einstein Healthcare Network, Philadelphia, PA.
J Hand Surg Am. 2020 May;45(5):452.e1-452.e8. doi: 10.1016/j.jhsa.2019.10.011. Epub 2019 Dec 20.
Distal oblique bundle (DOB) reconstruction for distal radioulnar joint (DRUJ) instability is an alternative to the Adams 2-incision distal radioulnar ligament reconstruction. The DOB reconstruction offers a single incision and is a technically less demanding procedure requiring a shorter tendon autograft. The DOB and Adams reconstruction may provide similar stability. This study sought to compare the biomechanical stability of the 2 DRUJ reconstructions. We hypothesized that DOB reconstruction would result in equivalent DRUJ translation, cyclic loading to failure, and maximal load to failure compared with the Adams reconstruction.
Ten fresh-frozen cadaver arms underwent DOB or Adams reconstructions. Volar, dorsal, and total translation of the radius relative to the ulna at the DRUJ were measured before and after each reconstruction. Translation was measured with a 20-N force in neutral position and 60° in pronation and supination. Measurements were obtained using a custom jig and electromagnetic motion-tracking system sensors. Total cycles and maximal load to failure of each reconstruction were measured and recorded using an electromechanical testing machine.
There was a DOB incidence of 70%. Distal radioulnar joint translation, total cycles, and failure load were similar for the 2 reconstructions. On average, the DOB reconstruction had less dorsal translation than did the Adams in supination. Translation in the DOB reconstruction was similar to that of native DRUJs. In supination, on average, the Adams reconstruction had greater total, volar, and dorsal translation compared with native DRUJs.
In terms of translation, cyclical loading, and maximal load to failure, the DOB reconstruction for DRUJ instability is similar to the Adams reconstruction.
This pilot study supports the DOB reconstruction as a possible alternative to the Adams reconstruction for DRUJ instability. The DOB reconstruction may theoretically reduce patient morbidity because it requires only one incision and a shorter tendon graft. However, further clinical and cadaveric studies are required to determine biomechanical equivalence and impact on patient morbidity.
对于远侧桡尺关节（DRUJ）不稳定，远侧斜束（DOB）重建术是亚当斯双切口远侧桡尺韧带重建术的一种替代方法。DOB重建术采用单一切口，技术要求较低，所需自体肌腱较短。DOB重建术和亚当斯重建术可能提供相似的稳定性。本研究旨在比较两种DRUJ重建术的生物力学稳定性。我们假设与亚当斯重建术相比，DOB重建术将导致DRUJ的平移、循环加载至失效和最大加载至失效情况相当。
对10只新鲜冷冻尸体手臂进行DOB或亚当斯重建术。在每次重建术前和术后，测量DRUJ处桡骨相对于尺骨的掌侧、背侧和总平移。在中立位、旋前60°和旋后60°时，用20 N的力测量平移。使用定制夹具和电磁运动跟踪系统传感器进行测量。使用机电测试机测量并记录每次重建术的总循环次数和最大失效载荷。
DOB发生率为70%。两种重建术的远侧桡尺关节平移、总循环次数和失效载荷相似。平均而言，DOB重建术在旋后时的背侧平移比亚当斯重建术少。DOB重建术中的平移与天然DRUJ相似。在旋后时，平均而言，亚当斯重建术与天然DRUJ相比，总平移、掌侧平移和背侧平移更大。
在平移、循环加载和最大失效载荷方面，用于DRUJ不稳定的DOB重建术与亚当斯重建术相似。
这项初步研究支持DOB重建术作为DRUJ不稳定时亚当斯重建术的一种可能替代方法。理论上，DOB重建术可能会降低患者的发病率，因为它只需要一个切口和较短的肌腱移植物。然而，需要进一步的临床和尸体研究来确定生物力学等效性以及对患者发病率的影响。
