CAJ | 학술논문

目的介绍自体掌长肌腱移植、远尺桡韧带解剖重建的适应证、手术方法及治疗慢性远尺桡关节(distal radioulnar joint,DRUJ)不稳定的初期随访结果.方法 2008年10月至2009年6月,应用自体掌长肌腱移植、远尺桡韧带解剖重建术治疗6例慢性DRUJ不稳定患者.平均年龄22岁.男4例,女2例.术中取腕背第四、五伸肌鞘管间纵行切口.切开鞘管,显露DRUJ背侧部分.横“L”形切开远尺桡背侧关节囊,显露DRUJ和三角纤维软骨盘.于桡骨远端尺背侧,距离月骨窝和乙状切迹各约5 mm处钻孔.在尺侧腕屈肌腱桡侧做掌侧纵行切口,切取全长掌长肌腱,将其一端通过桡骨隧道穿至掌侧,再用止血钳经三角纤维软骨盘下方透过掌侧关节囊,将其引至背侧.在尺骨颈和茎突隐窝之间钻孔.将肌腱两个断端经尺骨隧道引至尺骨颈处,再把其中一端绕过尺骨颈.将前臂置于中立位,抽紧缝合肌腱.术后长臂石膏固定前臂于中立位.4周后更换为前臂石膏,继续制动4周.结果所有患者术后均获得9～24个月随访,平均14个月.术后没有感染及感觉神经支损伤等并发症.疼痛减轻,握力增加.采用改良Mayo评分评估腕关节功能:术前平均69分,术后平均95分.5例患者对手术结果满意.结论韧带解剖重建术适用于无骨性关节炎的慢性DRUJ不稳定,术后腕关节功能改善明显.
목적 개소자체장장기건이식、원척뇨인대해부중건적괄응증、수술방법급치료만성원척뇨관절(distal radioulnar joint,DRUJ)불은정적초기수방결과.방법 2008년10월지2009년6월,응용자체장장기건이식、원척뇨인대해부중건술치료6례만성DRUJ불은정환자.평균년령22세.남4례,녀2례.술중취완배제사、오신기초관간종행절구.절개초관,현로DRUJ배측부분.횡“L”형절개원척뇨배측관절낭,현로DRUJ화삼각섬유연골반.우뇨골원단척배측,거리월골와화을상절적각약5 mm처찬공.재척측완굴기건뇨측주장측종행절구,절취전장장장기건,장기일단통과뇨골수도천지장측,재용지혈겸경삼각섬유연골반하방투과장측관절낭,장기인지배측.재척골경화경돌은와지간찬공.장기건량개단단경척골수도인지척골경처,재파기중일단요과척골경.장전비치우중립위,추긴봉합기건.술후장비석고고정전비우중립위.4주후경환위전비석고,계속제동4주.결과 소유환자술후균획득9～24개월수방,평균14개월.술후몰유감염급감각신경지손상등병발증.동통감경,악력증가.채용개량Mayo평분평고완관절공능:술전평균69분,술후평균95분.5례환자대수술결과만의.결론 인대해부중건술괄용우무골성관절염적만성DRUJ불은정,술후완관절공능개선명현.
Objective To introduce the indications and operative procedure of anatomic reconstruction of the distal radioulnar ligaments in patients with chronic instability of the distal radioulnar joint(DRUJ),and report its preliminary clinical results.Methods From October 2008 to June 2009,6 patients with instability of the DRUJ underwent anatomical reconstruction using a free palmaris longus tendon graft,including 4 males and 2 females with an average age of 22 years.A 5 cm dorsal incision was made between the fifth and sixth extensor compartments.An L-shaped flap was created in the DRUJ capsule.This flap is then elevated proximally to expose the articular surface of the DRUJ and the proximal triangular fibular cartilage complex (TFCC).A tunnel was made through the radius.The other tunnel was made between the ulnar neck and the fovea of the ulnar head.A whole-length palmaris longus tendon graft was taken.The volar opening of the radius tunnel was exposed through a longitudinal incision radial to the flexor carpi ulnaris tendon.One end of the graft was pulled to the palmar side easily through the tunnel.A hemostat was penetrated through the volar capsule to the volar side proximal to the remaining TFCC.The end of the graft was grasped with the hemostat and pulled back along this tract.Both graft limbs were passed through the ulnar tunnel to exit at the ulnar neck.One limb of the tendon was passed around the ulnar neck and deep to the ECU sheath.With the forearm in neutral rotation,the limbs were pulled taut,tied together,and secured with sutures.Immobilize the extremity in a long-arm plaster splint with the forearm in neutral position for 4 weeks,and changed to a short arm cast for an additional four weeks.Results The average follow-up period for all 6 patients was 14 months (range,9-24).No infection and sensory nerve branch disturbance occurred.The pain symptom was reduced and the grip force was improved significantly.A functional evaluation was performed using the modified Mayo wrist scoring system.All patients had better wrist scores postoperatively in the short (mean,95) term compared to preoperatively (mean,69).Five patients satisfied with the final result.Conclusion Anatomic reconstruction of the distal radioulnar ligaments is indicated for chronic DRUJ instability without osteoarthritis,it is a reliable method with a very good short term follow up result.Restoration of the radioulnar ligaments offers the best possibility to restore the normal DRUJ primary constraints and kinematics.