Thillemann Janni Kjærgaard, De Raedt Sepp, Hansen Torben Bæk, Munk Bo, Stilling Maiken
University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Lægaardvej 12, 7500, Holstebro, Denmark.
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
J Exp Orthop. 2021 Feb 4;8(1):10. doi: 10.1186/s40634-021-00329-y.
Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA).
In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair.
The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17).
In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.
由三角纤维软骨复合体（TFCC）损伤引起的桡尺远侧关节（DRUJ）症状性不稳定可采用多种手术技术进行治疗。DRUJ平移的临床检查具有主观性，且受观察者间差异的限制。本研究的目的是使用钢琴键试验和一种新的精确低剂量、非侵入性放射立体成像方法（自动放射立体分析，AutoRSA）比较两种不同手术方法对DRUJ平移的稳定效果。
在一项随机实验研究中，我们评估了10条人体尸体手臂（8例男性，平均年龄78岁）在切断TFCC的近端和远端附着点后，以及在进行开放性手术TFCC重新附着（n = 5）或使用掌长肌腱移植按照亚当斯方法进行TFCC重建（n = 5）后的DRUJ平移情况。将尸体手臂安装在定制的固定装置中进行标准化的钢琴键试验。记录放射立体图像，并使用AutoRSA软件进行图像分析。应用前臂计算机断层扫描骨模型的标准化解剖轴和坐标系来估计TFCC损伤后及手术修复后的DRUJ平移情况。
切断TFCC的近端和远端附着点后的DRUJ平移为2.48毫米（95%置信区间1.61；3.36）。小凹处TFCC重新附着使DRUJ平移减少了1.78毫米（95%置信区间0.82；2.74，p = 0.007），而TFCC重建使DRUJ平移减少了1.01毫米（95%置信区间 -1.58；3.60，p = 0.17）。
总之，小凹处TFCC重新附着显著降低了DRUJ平移，而亚当斯TFCC重建的稳定效果存在异质性。这支持了对于因急性小凹处TFCC损伤导致症状性DRUJ不稳定患者进行TFCC重新附着的临床建议。
