Darrow J C, Linscheid R L, Dobyns J H, Mann J M, Wood M B, Beckenbaugh R D
J Hand Surg Am. 1985 Jul;10(4):482-91. doi: 10.1016/s0363-5023(85)80069-1.
Thirty-six wrists of 35 patients were treated with distal ulnar recession for pain and limitation of motion associated with chondromalacia of the ulnar head, triangular fibrocartilage complex tears, ulnocarpal impingement, and instability of the distal radioulnar joint. Contributing factors were positive ulnar variance in 31 wrists, fracture of the distal radius in five, sprains in 14, premature closure of the distal radial epiphysis in five, and lax ligamentous habitus in five. The ages of the patients averaged 33 years. Clinical findings were local tenderness, crepitus, and instability evident by a positive "piano key" effect. Roentgenographic findings were positive ulnar variance (29 of 36), zero ulnar variance (four), negative ulnar variance (three), positive arthrogram (11 of 19), and "forme fruste" Madelung's deformity (two). The surgical procedure is a modification of the Milch cuff resection with the use of a dynamic compression plate. Recession ranged from 2 to 13 mm (average of 4 mm). Findings at surgery included chondromalacia of the ulnar head (19), tears of the triangular fibrocartilage complex (11), and excessive mobility of the ulnar head (10). At an average follow-up of 24.5 months, results were excellent in 7 wrists, good in 21, fair in four, and poor in four. Poor results in two wrists were upgraded to good after osteosynthesis of a nonunion in one and recessional osteotomy of the radial sigmoid notch in the other. Ulnar recession offers a less destructive alternative to disorders of the distal radioulnar joint than the Darrach resection.
对35例患者的36个腕关节进行了尺骨远端切除术，以治疗与尺骨头软骨软化、三角纤维软骨复合体撕裂、尺腕撞击及桡尺远侧关节不稳相关的疼痛和活动受限。促成因素包括31个腕关节存在正尺骨变异、5个桡骨远端远端 radius远端骨折、14个扭伤、5个桡骨远端骨骺过早闭合以及5个韧带松弛。患者平均年龄33岁。临床体征为局部压痛、摩擦音以及阳性“钢琴键”效应所显示的不稳。X线表现为正尺骨变异（36例中的29例）、零尺骨变异（4例）、负尺骨变异（3例）、阳性关节造影（19例中的11例）以及“类马德隆畸形”（2例）。手术方法是对米尔奇袖状切除术进行改良，使用动力加压钢板。尺骨远端切除范围为2至13毫米（平均4毫米）。手术所见包括尺骨头软骨软化（19例）、三角纤维软骨复合体撕裂（11例）以及尺骨头活动过度（10例）。平均随访24.5个月时结果如下：7个腕关节优，21个良，4个可，4个差。2个效果差的腕关节，其中1个经骨不连处骨合成、另1个经桡骨乙状切迹切骨术后，效果改善为良。与达拉赫切除术相比，尺骨远端切除术对桡尺远侧关节疾病的破坏性较小。
