CAJ | 학술논문

目的探讨创伤性桡尺远侧关节(distal radioulnar joint,DRUJ)背侧半脱位的治疗方法.方法 2010年8月至2014年6月,我们共收治28例不合并骨折的创伤性DRUJ背侧半脱位的患者.首先行保守治疗,前臂旋后位复位,然后屈肘90°位长臂石膏托固定6周,拆石膏后2个月内症状无明显缓解者认为无效.对无效者行桡尺韧带背侧浅部纤维加强术,术后旋后位长臂石膏托固定4周,然后改为短臂石膏托固定4周.结果术后随访时间为7个月至4.2年,平均2.5年.采用改良Mayo评分来评价腕关节功能.病程3周以内的14例患者保守治疗有效率为85.7％,病程3周以上的14例患者有效率为28.6％.对12例保守治疗失败者进行手术治疗,术后总体有效率为83.3％.结论创伤性DRUJ背侧半脱位早期诊断、早期治疗十分重要.病程超过3周保守治疗效果欠佳,对于保守治疗无效的DRUJ背侧半脱位患者取部分尺侧腕屈肌腱加强桡尺韧带背侧浅部纤维效果可靠.
목적 탐토창상성뇨척원측관절(distal radioulnar joint,DRUJ)배측반탈위적치료방법.방법 2010년8월지2014년6월,아문공수치28례불합병골절적창상성DRUJ배측반탈위적환자.수선행보수치료,전비선후위복위,연후굴주90°위장비석고탁고정6주,탁석고후2개월내증상무명현완해자인위무효.대무효자행뇨척인대배측천부섬유가강술,술후선후위장비석고탁고정4주,연후개위단비석고탁고정4주.결과 술후수방시간위7개월지4.2년,평균2.5년.채용개량Mayo평분래평개완관절공능.병정3주이내적14례환자보수치료유효솔위85.7％,병정3주이상적14례환자유효솔위28.6％.대12례보수치료실패자진행수술치료,술후총체유효솔위83.3％.결론 창상성DRUJ배측반탈위조기진단、조기치료십분중요.병정초과3주보수치료효과흠가,대우보수치료무효적DRUJ배측반탈위환자취부분척측완굴기건가강뇨척인대배측천부섬유효과가고.
Objective To explore a treatment protocol for acute and chronic traumatic dorsal subluxation of distal radioulnar joint (DRUJ) and report the preliminary clinical results.Methods From August 2010 to June 2014, 28 patients with traumatic DRUJ dorsal subluxation and without fractures were included in our standardized treatment protocol.First, a course of conservative treatment was applied to immobilize the affected limb at forearm supination and 90°elbow flexion with an above elbow plaster for 6 weeks after manual reduction of the DRUJ.Patients with no symptom relief in 2 months after plaster removal were regarded as non-responsive and were subject to surgical reinforcement of dorsal radioulnar ligament.The flexor carpi ulnaris tendon was split in the middle.The radial half was transversely divided 5 to 7 cm proximal to the pisiform bone, tunneled through the ulnar head in a volar-ulnar oblique to dorsal-radial direction, and then fixed over dorsal-ulnar side of the radius with 2 anchors.The extremity was then immobilized in an above elbow plaster with forearm in supination position for 4 weeks, followed by a short arm cast for another 4 weeks.Results The average follow-up time for all 28 patients was 2.5 years (range, 7 months to 4.2 years).A functional evaluation was performed with modified Mayo wrist scoring system.The effective rate of conservative treatment was 85.7％ for the 14 cases with less than 3 week post-injury interval and 28.6％ for the 14 cases with longer than 3 week post-injury interval.The effective rate of 12 cases that underwent surgical treatment was 83.3％.Conclusion Early diagnosis and early treatment for traumatic DRUJ dorsal subluxation is very important.Conservative treatment is less effective in cases of subluxation older than 3 weeks.For cases non-responsive to conservative treatment, surgical reinforcement of the dorsal superficial fibers of the radioulnar hgament with a tendon slip from flexor carpi ulnaris is a rehable solution.