Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY.
Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY.
J Hand Surg Am. 2020 Oct;45(10):909-917. doi: 10.1016/j.jhsa.2020.05.014. Epub 2020 Jul 18.
Distal radioulnar joint (DRUJ) instability may occur after an injury, resulting in pain and reduced strength. When primary repair is not possible or initial fixation has failed, chronic instability may result, requiring a reconstructive procedure such as the Adams procedure. The first purpose of this study was to evaluate the role of the triangular fibrocartilage complex and various components of the interosseous membrane as they were sectioned. The second purpose was to evaluate the Adams procedure in stabilizing the forearm.
Eight fresh cadaver forearms were dynamically moved through an average range of 56.8° pronation to 54.8° supination and tested first with the forearm intact and then after sectioning each of the following structures: the dorsal (DRUL) and palmar radioulnar ligaments (PRUL), the distal interosseous membrane, and the central band. Finally, they were tested after reconstruction using the Adams procedure. During each forearm motion and provocative shuck, the motion of the radius and ulna were measured and the locations of the radial attachments of the DRUL, PRUL, and sigmoid notch and ulnar fovea were computed.
Significant increases in the gap between the ulnar fovea and the attachment sites of the DRUL and PRUL were observed with incremental sectioning, most notably after sectioning of the central band. Reconstruction significantly reduced the gap at the DRUL and PRUL sites during dynamic motion.
This study reinforces the concept that DRUJ stability depends on more than the radioulnar ligaments, ulnocarpal ligaments, and triangular fibrocartilage complex, but is also significantly affected by the distal and central interosseous membrane. Reconstruction reduces gapping.
These results suggest that the Adams reconstruction is a reasonable option to address DRUJ instability but may be an incomplete solution in the setting of a ruptured interosseous ligament.
桡尺远侧关节 (DRUJ) 不稳定可能由损伤引起，导致疼痛和力量减弱。当无法进行初次修复或初始固定失败时，可能会导致慢性不稳定，需要进行重建手术，如亚当斯手术。本研究的首要目的是评估三角纤维软骨复合体和骨间膜的各个成分在被切断时的作用。第二个目的是评估亚当斯手术在稳定前臂方面的作用。
8 个新鲜的尸体前臂在平均 56.8°旋前至 54.8°旋后范围内进行动态运动，并首先在完整前臂的情况下进行测试，然后在切断以下每个结构后进行测试：背侧 (DRUL) 和掌侧桡尺韧带 (PRUL)、远侧骨间膜和中央带。最后，使用亚当斯手术进行重建后进行测试。在前臂运动和激发性摇晃过程中，测量桡骨和尺骨的运动，计算 DRUL、PRUL 和月状切迹及尺骨窝的桡骨附着位置。
随着逐渐的切断，尺骨窝和 DRUL、PRUL 附着点之间的间隙显著增加，尤其是在切断中央带后更为明显。重建在动态运动时显著减少了 DRUL 和 PRUL 部位的间隙。
本研究进一步证实了桡尺远侧关节的稳定性不仅依赖于桡尺侧韧带、尺侧腕骨韧带和三角纤维软骨复合体，还受到远侧和中央骨间膜的显著影响。重建可减少间隙。
这些结果表明，亚当斯重建是解决 DRUJ 不稳定的合理选择，但在骨间韧带断裂的情况下可能不是完整的解决方案。
