CAJ | 학술논문

目的探讨韧带重建治疗桡尺远侧关节(DRUJ)陈旧性背侧脱位的疗效与安全性.方法 2005年3月至2012年5月,应用自体掌长肌腱移植重建背侧韧带治疗7例DRUJ陈旧性背侧脱位.男4例,女3例;平均37岁.均有腕部外伤史,外伤后功能受限3个月以上,不合并骨折.术中在桡骨的尺背侧靠近尺切迹处钻一个平行于尺骨长轴的骨隧道,再于尺骨的尺侧伸腕肌腱沟向尺掌侧钻两个骨孔达尺骨外侧.切取掌长肌腱,穿过桡骨骨隧道,肌腱两端8字交叉后分别穿过尺骨两骨孔至尺骨尺掌侧,前臂旋后位复位DRUJ拉紧肌腱缝合固定.肌腱的游离端返折重建尺侧腕伸肌腱腱鞘.术后长臂石膏屈肘90°、前臂旋后位固定,3周后更换短臂石膏,继续固定3周.无尺神经感觉支损伤等并发症.结果本组7例均得到随访,随访20～ 50个月,平均33个月.腕部旋转明显改善,握力增加.采用改良Mayo腕关节功能评分方法评分,术前平均68分,术后平均93分.7例患者对治疗结果均满意.结论韧带重建治疗DRUJ陈旧性背侧脱位有效、安全.
목적 탐토인대중건치료뇨척원측관절(DRUJ)진구성배측탈위적료효여안전성.방법 2005년3월지2012년5월,응용자체장장기건이식중건배측인대치료7례DRUJ진구성배측탈위.남4례,녀3례;평균37세.균유완부외상사,외상후공능수한3개월이상,불합병골절.술중재뇨골적척배측고근척절적처찬일개평행우척골장축적골수도,재우척골적척측신완기건구향척장측찬량개골공체척골외측.절취장장기건,천과뇨골골수도,기건량단8자교차후분별천과척골량골공지척골척장측,전비선후위복위DRUJ랍긴기건봉합고정.기건적유리단반절중건척측완신기건건초.술후장비석고굴주90°、전비선후위고정,3주후경환단비석고,계속고정3주.무척신경감각지손상등병발증.결과 본조7례균득도수방,수방20～ 50개월,평균33개월.완부선전명현개선,악력증가.채용개량Mayo완관절공능평분방법평분,술전평균68분,술후평균93분.7례환자대치료결과균만의.결론 인대중건치료DRUJ진구성배측탈위유효、안전.
Objective To evaluate the efficacy and safety of dorsal ligament reconstruction in treatment of old dorsal dislocation of distal radioulnar joint.Methods Seven patients with old dorsal dislocation of distal radioulnar joint were treated with dorsal ligament reconstruction using the palmaris longus tendon from March 2005 to May 2012 in our institute,including 4 males and 3 females with a mean age of 37 years.All patients had a history of wrist injury for more than 3 months and were diagnosed as isolated dislocation of distal radioulnar joint without fractures.During the operation a bone tunnel was made at dorsal ulnar side of radius near the ulnar notch,which was parallelized to long axial of ulna,two holes were drilled from dorsal to palmarulnaris side through the extensor carpi ulnaris sulcus of the ulna.The palmaris longus tendon was harvested and the strip of the tendon was penetrated through the radial hole.After the tips being crossed,put them through the holes of ulna,reduct the distal radioulnar joint by supinating the forearm,the strip of the tendon was sutured after being tightened,the reversed back the free end of the tendon to reconstruct the sheath of extensor carpi ulnaris tendon.Postoperatively,the upper extremity were kept in a long arm plaster in the position of elbow flexion 90° and forearm supination for 3 weeks,then the below elbow cast was replaced for another 3 weeks.Results Patients were followed-up for 1 year and 8 months 4 years and 2 months with the average of 2 years and 9 months.The rotation of wrist was improved and the handgrip strength was increased significantly.A functional evaluation was performed using the modified Mayo wrist scoring system.All patients had better wrists scores postoperatively (mean,93) compared to preoperatively (mean,68).All patients satisfied with the final result.Conclusion Dorsal ligament reconstruction should be a promise surgical modality for the old dorsal dislocation of distal radioulnar joint.