尺骨正向变异患者中远侧桡尺关节方向和月骨形态作为症状性特发性尺骨撞击综合征的保护因素

Distal Radioulnar Joint Orientation and Lunate Morphology as Protective Factors of Symptomatic Idiopathic Ulnar Impaction Syndrome in Ulnar-Positive Variant Patients.

作者信息

Shin Seong Kee, Kim Ki Hong, Kim Kyu Jin

机构信息

Department of Orthopedic Surgery, Seoul Medical Center, Jungnang-gu, Seoul, Republic of Korea.

出版信息

J Wrist Surg. 2024 Jul 25;14(5):454-460. doi: 10.1055/s-0044-1788706. eCollection 2025 Oct.

DOI:10.1055/s-0044-1788706

PMID:40995544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12456978/

Abstract

BACKGROUND

Ulnar-positive variance is widely recognized as a risk factor for idiopathic ulnar impaction syndrome (UIS). However, not all patients with ulnar-positive variance progress to symptomatic UIS. Other factors, such as the shape of the lunate or the distal radioulnar joint (DRUJ), may also play a role. This study aims to elucidate the relationship between the shape of the lunate and the structure of the DRUJ and idiopathic UIS.

MATERIALS AND METHODS

A cohort of 40 cases diagnosed with idiopathic UIS (UIS group) and 87 control subjects with ulnar-positive variance but without symptoms were compared. Lunate shape was assessed by measuring the lunate type and radiolunate angle (RLA), whereas DRUJ morphology was evaluated using the sigmoid notch angle, DRUJ subluxation ratio, and DRUJ inclination. Independent -tests were conducted to analyze differences in radiographic metrics between the two groups, and logistic regression analyses were used to examine risk factors for idiopathic UIS. Receiver operating characteristic curves were utilized to determine the cutoff values for statistically significant variables.

RESULTS

Significant differences were observed between the two groups in terms of RLA, DRUJ subluxation ratio, and DRUJ inclination ( < 0.05). Logistic multiple regression analysis revealed a negative correlation between idiopathic UIS occurrence and both RLA (odds ratio [OR]: 0.92; 95% confidence interval [CI]: 0.87-0.96; < 0.001) and the DRUJ subluxation ratio (OR: 0.01; 95% CI: 0-0.07; = 0.002). Conversely, a positive correlation was found between UIS occurrence and DRUJ inclination (OR: 1.06; 95% CI: 1.01-1.12; = 0.021).

CONCLUSION

In patients with ulnar-positive variance, the incidence of symptomatic UIS decreases when the lunate extends more relative to the radius and when the DRUJ subluxation ratio increases or DRUJ inclination decreases.

LEVEL OF EVIDENCE

Level III, case-control study.

摘要

背景

尺骨正向变异被广泛认为是特发性尺骨撞击综合征（UIS）的一个危险因素。然而，并非所有尺骨正向变异的患者都会发展为有症状的UIS。其他因素，如月骨的形状或远侧桡尺关节（DRUJ），也可能起作用。本研究旨在阐明月骨形状、DRUJ结构与特发性UIS之间的关系。

材料与方法

比较了40例诊断为特发性UIS的病例（UIS组）和87例尺骨正向变异但无症状的对照者。通过测量月骨类型和桡月角（RLA）评估月骨形状，而使用乙状切迹角、DRUJ半脱位率和DRUJ倾斜度评估DRUJ形态。进行独立t检验以分析两组之间影像学指标的差异，并使用逻辑回归分析检查特发性UIS的危险因素。利用受试者工作特征曲线确定具有统计学意义变量的临界值。

结果

两组在RLA、DRUJ半脱位率和DRUJ倾斜度方面观察到显著差异（P＜0.05）。逻辑多元回归分析显示特发性UIS的发生与RLA（比值比[OR]：0.92；95%置信区间[CI]：0.87 - 0.96；P＜0.001）和DRUJ半脱位率（OR：0.01；95%CI：0 - 0.07；P = 0.002）均呈负相关。相反，发现UIS的发生与DRUJ倾斜度呈正相关（OR：1.06；95%CI：1.01 - 1.12；P = 0.021）。