Hand Trauma Centre, Elisabethenstraße 19, 88212 Ravensburg, Germany; Department of Traumatology, University of Szeged, 6725 Szeged, Semmelweis u. 6, Hungary.
Hand Trauma Centre, Elisabethenstraße 19, 88212 Ravensburg, Germany.
Injury. 2024 Sep;55 Suppl 3:111455. doi: 10.1016/j.injury.2024.111455. Epub 2024 Sep 17.
Posttraumatic or congenital ulna-minus variance with altered shape of the sigmoid notch and increased tension of the distal oblique band of the interosseous membrane (DIOM) can lead to painful impingement in the distal radioulnar joint (DRUJ) during rotation and loading of the forearm. As an operative treatment concept, a new method was described in 2016. Its goal is to restore the osseous congruency, which is required for normal painless function. The hypothesis is based on remodelling of the joint surface and the decompression of the DRUJ by releasing the DIOM. The purpose of this study is to analyze the results of performed operations with detailed focus on posttraumatic cases.
The indication for the operation is the impingement and incongruency in the DRUJ with ulna-minus variance. The surgical procedure is based on shortening and closed-wedge osteotomy of the distal radius with an ulnar translation of the radial shaft. Fifty-nine operations were performed between 2011 - 2022 on 52 patients (13 men, 39 women). Twenty-four patients were operated on the right side, 21 on the left side and 7 bilaterally. In 45 cases the operation was indicated because of congenital, in 12 cases due to posttraumatic incongruency and in 2 cases because of iatrogenic impingement after previously performed excessive ulnar shortening osteotomy. Modified Mayo-Wrist-Score, patient questioning, VAS and ROM were used to evaluate the results.
Significant reduction of pain on VAS from 7.22 to 1.98 (p < .001) was achieved. The pre- and postoperative range of motion did not show any significant changes (mean total arc of motion 301,94° vs. 295,20°, p = .300). Specific complications we observed included a too distally performed osteotomy, DRUJ instability, de Quervain´s tenosynovitis, persistent pain and conversion into an ulna-plus variance.
Under consideration of the indication criteria and correct execution of the osteotomy, in about 90 % of the cases this operation leads to good-to-excellent results with pain reduction and improvement of weight-bearing and power. The preoperative examination, verification of the DRUJ stability and the radiological diagnostics are crucial for a good outcome.
创伤后或先天性尺骨缺失伴月状切迹形态改变和骨间膜远端斜带张力增加（DIOM）可导致前臂旋转和负重时远端尺桡关节（DRUJ）疼痛性撞击。作为一种手术治疗方法，2016 年描述了一种新方法。其目的是恢复正常无痛功能所需的骨性一致性。该假说基于关节表面的重塑和通过释放 DIOM 来减压 DRUJ。本研究的目的是分析已进行手术的结果，并详细关注创伤后病例。
手术指征为 DRUJ 撞击和尺骨缺失伴不匀。手术过程基于桡骨远端缩短和闭合楔形截骨，并伴有桡骨轴向向尺侧平移。2011 年至 2022 年期间，对 52 名患者（13 名男性，39 名女性）的 59 例手术进行了分析。24 例患者行右侧手术，21 例行左侧手术，7 例行双侧手术。45 例因先天性原因，12 例因创伤后不匀，2 例因先前行过度尺骨缩短截骨术后医源性撞击而手术。改良 Mayo-Wrist-Score、患者询问、VAS 和 ROM 用于评估结果。
VAS 疼痛评分从 7.22 显著降低至 1.98（p <.001）。术前和术后的活动范围没有显示出任何显著变化（平均总活动弧 301.94°比 295.20°，p =.300）。我们观察到的特定并发症包括截骨位置过于远侧、DRUJ 不稳定、De Quervain 腱鞘炎、持续性疼痛和转变为尺骨正变异。
考虑到适应证标准和截骨术的正确执行，该手术约 90%的病例可导致疼痛减轻、负重和力量改善的良好至优秀结果。术前检查、DRUJ 稳定性验证和影像学诊断对于获得良好结果至关重要。
