Department of Orthopedic Surgery, Kwano-Kyoritsu Hospital, Fukushima, Japan.
J Hand Surg Asian Pac Vol. 2021 Mar;26(1):70-76. doi: 10.1142/S2424835521500119.
Treatment of the proximal ulnar stump with the Darrach or Sauvé-Kapandji (SK) procedure remains controversial. Ulnar wrist symptoms can result, and although many surgeons attribute these to ulnar stump instability, they can also be caused by radioulnar convergence or stump irritation. We present a novel surgical method for protecting the proximal ulnar stump and avoiding these complications. Our cases were five men and five women (mean age 72.0 years, range, 34-89). Mean follow-up duration was 41.7 months (range, 6-101 months). Radiological findings were osteoarthritis in five, rheumatoid arthritis of distal radioulnar joint in three, and ulnocarpal abutment syndrome in two. Pronator quadratus (PQ) was released from its insertion on the radius and transferred dorsally to cover the proximal ulnar stump. Postoperative ulnar wrist symptoms such as ulnar stump tenderness, forearm range of motion, and grip strength were compared with contralateral values. Dynamic radioulnar impingement was evaluated by Lee and Scheker's stress roentgenogram. Nine patients completed the Patient Rated Wrist Evaluation (PRWE) at final follow-up. No patients reported ulnar wrist pain or tenderness at the proximal ulnar stump. Postoperative forearm range of motion recovered almost to contralateral values in cases without preoperative forearm contracture. In the two cases with contracture, postoperative pronation and supination recovered to more than their preoperative range. Grip strength averaged 86.4% (range, 66.7-103%) of the contralateral value at final follow-up. Lees and Scheker's stress roentgenogram revealed marked radioulnar impingement in one case, mild impingement in four cases and none in five, yet no patient complained of pain during the maneuver. The mean PRWE score was 34.7 points (range, 0-52.5 points). Insertion-released PQ pedicle transfer is an effective treatment option for the proximal ulnar stump after the Darrach or SK procedure.
尺骨残端的治疗采用 Darrach 或 Sauvé-Kapandji（SK）手术仍存在争议。可能会出现尺侧腕部症状，尽管许多外科医生将其归因于尺骨残端不稳定，但也可能是由桡尺骨会聚或残端刺激引起的。我们提出了一种保护尺骨残端并避免这些并发症的新手术方法。我们的病例为 5 名男性和 5 名女性（平均年龄 72.0 岁，范围 34-89 岁）。平均随访时间为 41.7 个月（范围 6-101 个月）。影像学发现 5 例为骨关节炎，3 例为桡尺远侧关节类风湿关节炎，2 例为尺腕撞击综合征。旋前方肌（PQ）从其在桡骨上的止点处松解，并向背侧转移以覆盖尺骨残端。比较术后尺侧腕部症状（如尺骨残端压痛、前臂活动范围和握力）与对侧值。通过 Lee 和 Scheker 的应力 X 线片评估动态桡尺骨撞击。9 例患者在最终随访时完成了患者自评手腕评估（PRWE）。无患者报告尺骨残端近端的尺侧腕部疼痛或压痛。在没有术前前臂挛缩的情况下，术后前臂活动范围几乎恢复到对侧值。在 2 例挛缩的情况下，术后旋前和旋后恢复到超过术前范围。最终随访时，握力平均为对侧值的 86.4%（范围 66.7-103%）。Lee 和 Scheker 的应力 X 线片显示 1 例存在明显桡尺骨撞击，4 例存在轻度撞击，5 例无撞击，但在操作过程中无患者主诉疼痛。平均 PRWE 评分为 34.7 分（范围 0-52.5 分）。尺骨残端的插入松解后的旋前方肌蒂转移是 Darrach 或 SK 手术后尺骨残端的有效治疗选择。
