Service de chirurgie orthopédique du centre hospitalier de Mont-de-Marsan, 417, avenue Pierre-de-Coubertin, BP 417, 40024 Mont-de-Marsan cedex, France.
Service de chirurgie orthopédique du centre hospitalier de Niort, 40, avenue Charles-de-Gaulle, BP 70600, 79021 Niort cedex, France.
Orthop Traumatol Surg Res. 2020 Dec;106(8):1581-1587. doi: 10.1016/j.otsr.2020.03.041. Epub 2020 Oct 17.
The distal radioulnar (DRU) ligaments play a key role in stabilizing the DRU joint. Ligament reconstruction in this area is an accepted treatment. However, another structure may also be a significant DRUJ stabilizer-the distal oblique bundle (DOB) of the interosseous membrane (IOM). Recent studies have described DOB reconstruction methods, which should be compared to DRU ligament reconstruction.
Twelve upper limbs were used. First, a descriptive anatomy study was done to determine the prevalence and features of the DOB (insertions, thickness, and relationship with DRU ligaments). Second, biomechanical testing was done with the wrist in neutral position, supination, and pronation. Distal radius translation was evaluated first on an intact wrist then evaluated again after creating bidirectional instability. Lastly, the same tests were repeated after DRU reconstruction using the Adams-Berger technique and DOB reconstruction using the Riggenbach technique.
The DOB was present in 50% of specimens and was bilateral. Reconstructing the DOB stabilized the wrist to the same degree as the Adams-Berger technique in neutral and pronation (8% residual major instability). Stability was harder to achieve in supination (25% major instability). It was better at controlling posterior radial translation than anterior translation (3% versus 14% major instability).
DOB reconstruction appears to be a reliable and less invasive treatment option for DRUJ instability since it is extra-articular. However, the wrist's position and the direction of radial translation seem to alter the stabilization's effectiveness.
IV; Cadaver study.
桡尺远侧（DRU）韧带在稳定 DRU 关节中起着关键作用。该区域的韧带重建是一种被接受的治疗方法。然而，另一个结构也可能是 DRUJ 的重要稳定器——骨间膜的远侧斜束（DOB）。最近的研究已经描述了 DOB 重建方法，应将其与 DRU 韧带重建进行比较。
使用了 12 个上肢。首先，进行描述性解剖学研究，以确定 DOB 的发生率和特征（插入、厚度以及与 DRU 韧带的关系）。其次，在中立位、旋后位和旋前位下进行生物力学测试。首先评估完整腕关节的桡骨远端平移，然后在创建双向不稳定后再次评估。最后，在使用 Adams-Berger 技术进行 DRU 重建和使用 Riggenbach 技术进行 DOB 重建后，重复相同的测试。
DOB 存在于 50%的标本中，且为双侧。重建 DOB 可使腕关节在中立位和旋前位与 Adams-Berger 技术一样稳定（8%残留主要不稳定）。在旋后位时更难实现稳定性（25%主要不稳定）。它在控制后向桡骨平移方面优于前向平移（3%对 14%主要不稳定）。
DOB 重建似乎是一种可靠且微创的 DRUJ 不稳定治疗选择，因为它是关节外的。然而，腕关节的位置和桡骨平移的方向似乎会改变稳定的效果。
IV；尸体研究。
