Medical College, Soochow University, Suzhou, China.
Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, Liangxi Road No. 999, Wuxi, Jiangsu, China.
BMC Musculoskelet Disord. 2024 Jun 8;25(1):454. doi: 10.1186/s12891-024-07562-3.
Ulnar impingement syndrome is a prevalent source of ulnar carpal pain; however, there is ongoing debate regarding the specific location of shortening, the method of osteotomy, the extent of shortening, and the resulting biomechanical alterations.
To investigate the biomechanical changes in the distal radioulnar joint (DRUJ) resulting from different osteotomy methods, a cadaveric specimen was dissected, and the presence of a stable DRUJ structure was confirmed. Subsequently, three-dimensional data of the specimen were obtained using a CT scan, and finite element analysis was conducted after additional processing.
The DRUJ stress did not change significantly at the metaphyseal osteotomy of 2-3 mm but increased significantly when the osteotomy length reached 5 mm. When the osteotomy was performed at the diaphysis, the DRUJ stress increased with the osteotomy length, and the increase was greater than that of metaphyseal osteotomy. Stress on the DRUJ significantly increases when the position is changed to pronation dorsi-extension. Similarly, the increase in stress in diaphyseal osteotomy was greater than that in metaphyseal osteotomy. When the model was subjected to a longitudinal load of 100 N, neither osteotomy showed a significant change in DRUJ stress at the neutral position. However, the 100 N load significantly increased stress on the DRUJ when the position was changed to pronation dorsi-extension, and the diaphyseal osteotomy significantly increased stress on the DRUJ.
For patients with distal oblique bundle, metaphyseal osteotomy result in a lower increase in intra-articular pressure in the DRUJ compared to diaphyseal osteotomy. However, it is crucial to note that regardless of the specific type of osteotomy employed, it is advisable to avoid a shortening length exceeding 5 mm.
尺侧腕撞击综合征是尺腕痛的常见原因；然而，对于缩短的具体位置、截骨方法、缩短程度以及由此产生的生物力学改变，仍存在争议。
为了研究不同截骨方法对下尺桡关节（DRUJ）的生物力学变化，对一具尸体标本进行解剖，并确认 DRUJ 结构的稳定性。随后，使用 CT 扫描获得标本的三维数据，并进行进一步处理后的有限元分析。
在 2-3mm 干骺端截骨时，DRUJ 应力没有明显变化，但当截骨长度达到 5mm 时，DRUJ 应力明显增加。当在骨干进行截骨时，DRUJ 应力随截骨长度增加而增加，且增加幅度大于干骺端截骨。当位置变为旋前背伸时，DRUJ 上的应力显著增加。同样，骨干截骨的应力增加大于干骺端截骨。当模型受到 100N 的纵向载荷时，在中立位时，两种截骨方式均不会使 DRUJ 上的应力发生显著变化。然而，当位置变为旋前背伸时，100N 的载荷会显著增加 DRUJ 上的应力，且骨干截骨会显著增加 DRUJ 上的应力。
对于远端斜束患者，与骨干截骨相比，干骺端截骨会使 DRUJ 关节内压力增加较低。然而，需要注意的是，无论采用哪种具体类型的截骨术，都应避免缩短长度超过 5mm。
