Hagert C G
Department of Orthopaedics, Lund University Hospital, Sweden.
Handchir Mikrochir Plast Chir. 1994 Jan;26(1):22-6.
The ulna represents the non-rotating, stable and weightbearing part of the forearm around which the radius rotates in pronation and supination. The distal radioulnar joint is the distal half of an articulation, the proximal half of which is the proximal radioulnar joint. In spite of the distance between the two, the distal and proximal radioulnar joints together form a bi-condylar joint, the "forearm joint", with the axis of rotation running from the centre of the radial head out distally into the interosseous space towards the centre of the ulnar head. The end of the radius together with the hand and what is held in the hand will rest against the stable, immobile ulnar head, which acts as the keystone of the wrist. Mobility and stability of the distal radioulnar joint is accomplished by the combined action between fully congruent articulating surfaces and intact radioulnar ligaments. Following a distal radius fracture, the semilunar notch of the radius will no longer be congruent to the ulnar head due to the displacement of the distal fracture fragment of the radius into either dorsal angulation, radial angulation, or both. The stabilizing ligaments will tear. Any posttraumatic disabling dysfunction of the distal radioulnar joint should accordingly be treated by a corrective osteotomy of the radius at the fracture site in order to achieve full congruity between the semilunar notch and the ulnar head. Resection of the ulnar head deprives the wrist its keystone and should therefore be avoided.
尺骨是前臂不旋转、稳定且负重的部分，桡骨围绕其进行旋前和旋后运动。桡尺远侧关节是一个关节的远侧半部，其近侧半部是桡尺近侧关节。尽管两者之间有一定距离，但桡尺远侧关节和桡尺近侧关节共同构成一个双髁关节，即“前臂关节”，其旋转轴从桡骨头中心向远侧延伸至骨间间隙，朝向尺骨头中心。桡骨末端连同手及手中所持之物将靠在稳定、不动的尺骨头上，尺骨头起着腕关节的关键作用。桡尺远侧关节的活动度和稳定性通过完全匹配的关节面和完整的桡尺韧带共同作用来实现。桡骨远端骨折后由于桡骨远端骨折块向背侧成角、桡侧成角或两者皆有移位，桡骨的半月形切迹将不再与尺骨头匹配。稳定韧带会撕裂。因此，对于桡尺远侧关节任何创伤后致残性功能障碍，应通过在骨折部位对桡骨进行截骨矫正术来治疗，以实现半月形切迹与尺骨头之间的完全匹配。切除尺骨头会使腕关节失去其关键支撑，因此应避免。
