McKee M D, Richards R R
St Michael's Hospital, Toronto, Canada.
J Bone Joint Surg Br. 1996 May;78(3):413-8.
We reviewed 23 patients who had had 25 Darrach procedures for traumatic or post-traumatic disorders of the wrist at a mean follow-up of 75.5 months (36 to 121). The mean age at the time of operation was 61.1 years (34 to 82). All patients were reviewed in person. Assessment included a history, a questionnaire on patient satisfaction and a detailed physical examination. Standardised radiographs of both wrists were taken with the patient's hands in a resting position and during maximal grip. Convergence of the distal ulnar stump towards the distal radius during maximal grip (dynamic radio-ulnar convergence) was seen in 14 wrists including five with actual contact (dynamic radio-ulnar impingement), but this produced symptoms in only two cases. The presence of dynamic radio-ulnar convergence did not correlate with grip strength, pinch strength, range of movement or wrist score, but was associated with increased length of excision of the distal ulna. Nineteen of the 23 patients were satisfied with the procedure. Dynamic radio-ulnar convergence is common after the Darrach procedure, but is rarely symptomatic; resection of the distal ulna remains a reliable procedure in the older patient with pain and loss of movement. Excision of the lower end of the ulna should be restricted to the least required to restore full rotation.
我们回顾了23例患者，他们因腕部创伤性或创伤后疾病接受了25次Darrach手术，平均随访时间为75.5个月（36至121个月）。手术时的平均年龄为61.1岁（34至82岁）。所有患者均接受了亲自检查。评估内容包括病史、患者满意度问卷和详细的体格检查。在患者手部处于休息位和最大握力时拍摄双腕的标准X线片。在14例手腕中观察到在最大握力时尺骨远端残端向桡骨远端汇聚（动态桡尺汇聚），其中5例存在实际接触（动态桡尺撞击），但仅2例出现症状。动态桡尺汇聚的存在与握力、捏力、活动范围或腕部评分无关，但与尺骨远端切除长度增加有关。23例患者中有19例对该手术满意。Darrach手术后动态桡尺汇聚很常见，但很少有症状；对于有疼痛和活动丧失的老年患者，尺骨远端切除术仍然是一种可靠的手术方法。尺骨下端的切除应限制在恢复完全旋转所需的最小范围内。
