Ohara Takeru, Yamazaki Takahiro, Matsuura Yusuke, Suzuki Takane, Ohtori Seiji
Orthopedic Surgery, Chiba University's Graduate School of Medicine, Chiba, JPN.
Orthopaedics, Chiba University Hospital, Chiba, JPN.
Cureus. 2023 Jun 29;15(6):e41163. doi: 10.7759/cureus.41163. eCollection 2023 Jun.
Salvage procedures for distal radioulnar joint (DRUJ) arthritis, like the Darrach or Sauvé-Kapandji (S-K) procedures, often result in extensor tendon ruptures at the ulnar stump. Radioulnar instability is considered the underlying cause and stump stabilization techniques are employed. This study investigated radioulnar instability, extensor tendon irritation, and the effectiveness of stump stabilization techniques following salvage procedures.
Six upper limbs from three cadavers were used. Forearm rotation was measured using magnetic position sensors to assess radial movement. The Darrach procedure was performed on two limbs, comparing radial motion ranges for different ulnar osteotomy positions. The risk of tendon rupture was assessed with applied weight. The S-K procedure was performed on four limbs, evaluating stump stabilization techniques and radial movement distance underweight.
Proximal osteotomy positions increased radial motion range. Extensor tendon irritation occurred when the load was applied to the volar and ulnar sides, particularly with a pronated forearm. Stump stabilization techniques did not significantly contribute to ulnar stump stabilization.
Proximal ulnar osteotomy positions in DRUJ salvage procedures led to increased radioulnar instability and potential complications. Load application on the volar and ulnar sides, especially in a pronated forearm, increased the risk of tendon rupture. Stump stabilization techniques showed limited utility in stabilizing the ulnar stump or reducing complications. These findings can inform strategies for minimizing complications in DRUJ salvage procedures.
桡尺远侧关节（DRUJ）关节炎的挽救手术，如Darrach或Sauvé-Kapandji（S-K）手术，常常导致尺骨残端的伸肌腱断裂。桡尺关节不稳定被认为是根本原因，因此采用了残端稳定技术。本研究调查了挽救手术后的桡尺关节不稳定、伸肌腱刺激情况以及残端稳定技术的有效性。
使用来自三具尸体的六条上肢。通过磁性位置传感器测量前臂旋转，以评估桡骨运动。对两条上肢进行Darrach手术，比较不同尺骨截骨位置的桡骨运动范围。通过施加重量评估肌腱断裂的风险。对四条上肢进行S-K手术，评估残端稳定技术以及负重情况下的桡骨移动距离。
近端截骨位置增加了桡骨运动范围。当向掌侧和尺侧施加负荷时，尤其是在前臂旋前时，会发生伸肌腱刺激。残端稳定技术对尺骨残端稳定没有显著作用。
DRUJ挽救手术中的近端尺骨截骨位置会导致桡尺关节不稳定增加和潜在并发症。在掌侧和尺侧施加负荷，尤其是在前臂旋前时，会增加肌腱断裂的风险。残端稳定技术在稳定尺骨残端或减少并发症方面显示出有限的效用。这些发现可为尽量减少DRUJ挽救手术并发症的策略提供参考。
