Hearon Bernard F, Frantz Lisa M, Helsper Elizabeth A, Morris Harry A
Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas.
Advanced Orthopaedic Associates, Wichita, Kansas.
J Wrist Surg. 2021 Oct;10(5):392-400. doi: 10.1055/s-0041-1726408. Epub 2021 Mar 24.
The aim of this study is to review our cumulative experience with diagnosis and treatment of distal radioulnar joint (DRUJ) instability and to present our treatment algorithm. Retrospective review identified 112 patients who had 126 episodes of care for DRUJ instability at a single institution over a 21-year period. Those diagnosed acutely or subacutely were treated with immobilization of the wrist and elbow for 6 weeks, while those with chronic instability had anatomic reconstruction of the dorsal and palmar radioulnar ligaments with tendon autograft or an alternative arthroscopic treatment with our thermal annealing technique. Short-term treatment failures and surgical complications were recorded. Nonparametric statistical tests were used to analyze key long-term outcome measures including ulnar wrist pain and DRUJ stability indicated by the dorsopalmar stress test. At mean 7-year follow-up, eight patients in the acute-injury cohort had statistically significant improvements in wrist pain and DRUJ instability ( < 0.001). In both the 22-patient anatomic reconstruction cohort and the 37-patient arthroscopically treated group, there were also statistically significant improvements in wrist pain and DRUJ stability ( < 0.001) at mean 9-year follow-up. The majority of patients in all three groups was satisfied with treatment outcome, though some required secondary procedures. Early clinical diagnosis of DRUJ instability using the dorsopalmar stress test provides an opportunity for effective nonsurgical treatment. For chronic presentation, we recommend our arthroscopic thermal annealing technique for mild or moderate instability and open anatomic reconstruction of the radioulnar ligaments for severe instability. This is a Level IV, therapeutic study.
本研究的目的是回顾我们在桡尺远侧关节（DRUJ）不稳定诊断和治疗方面的累积经验，并展示我们的治疗算法。 回顾性研究确定了112例患者，他们在21年期间于单一机构接受了126次DRUJ不稳定的治疗。急性或亚急性诊断的患者采用手腕和肘部固定6周的治疗方法，而慢性不稳定患者则采用自体肌腱移植对背侧和掌侧桡尺韧带进行解剖重建，或采用我们的热退火技术进行另一种关节镜治疗。记录短期治疗失败和手术并发症。使用非参数统计测试分析关键的长期结果指标，包括尺侧腕部疼痛和背掌侧应力试验所显示的DRUJ稳定性。 在平均7年的随访中，急性损伤队列中的8例患者在腕部疼痛和DRUJ不稳定方面有统计学上的显著改善（ <0.001）。在22例解剖重建队列和37例关节镜治疗组中，平均9年随访时腕部疼痛和DRUJ稳定性也有统计学上的显著改善（ <0.001）。所有三组中的大多数患者对治疗结果满意，尽管有些患者需要二次手术。 使用背掌侧应力试验对DRUJ不稳定进行早期临床诊断为有效的非手术治疗提供了机会。对于慢性病例，我们建议对于轻度或中度不稳定采用关节镜热退火技术，对于严重不稳定采用桡尺韧带的开放解剖重建。 这是一项IV级治疗性研究。
