下尺桡关节损伤后解剖学修复及其功能重建特征

Anatomic plerosis and the character of functional restoration after the injuries of distal radioulnar joint

目的:总结近年来下尺桡关节损伤在解剖、生物力学、损伤机制、诊断特点和治疗方面的研究进展,并对不同的治疗方法进行评估。资料来源:应用计算机检索下尺桡关节损伤方面的文献。①对www.ncbi.nlm.nih.gov/PubMed2003-01/2005-04文献进行检索,检索词为“thedis-tal radioulnar joint”,限定文章语言为English。②同时检索http://www.wanfangdata.com.cn/1995-01/2004-12文献,检索词为“下尺桡关节”,限定文章语言种类为中文。资料选择:纳入条件:①实验研究。②临床研究。排除条件:①下尺桡关节肿瘤、畸形、退行性变类文献。②重复研究文献。③综述文献。资料提炼:共收集到141篇关于下尺桡关节的解剖、生物力学、损伤机制、诊断特点和治疗方面的文章,重点引用文献23篇,排除118篇。资料综合:①解剖和生物力学:在外科手术中,如果要保持正常的生物力学,下尺桡关节的解剖完整性应该保持。②损伤机制和诊断特点:对前臂损伤进行详细的查体尤其重要,一定要对受伤部位的上下关节详细检查,并对肘关节损伤患者的下尺桡关节不稳定有清楚认识。利用一些较新的技术能增加早期诊断正确率。③治疗:下尺桡关节损伤保守治疗:采用前臂完全旋后位夹板固定治疗下尺桡关节背侧脱位(Ⅰ型脱位)36例,效果优良;;早期手术治疗:手法复位后直接经皮钳固定下尺桡关节脱位,这种方法具有固定物体积小,固定牢,操作简单的优点;;晚期则必须进行补救手术,包括尺骨小头切除术、Sauve-Kapandji术、韧带转位重建术、旋前方肌骨膜瓣转位术、尺骨缩短或桡骨延长术等,各手术有其各自优缺点及适应症,但或多或少都残留一定的后遗症,应尽量做到远端尺桡关节的解剖学重建。结论:下尺桡关节损伤应该引起临床医师的重视,如何有效的早期诊断和有效的避免后遗症将是今后研究的发展方向。

OBJECTIVE： To summarize the progression in the study of distal radioulnar joint injuries in the following aspects： anatomy, biomechanies, injured mechanism, diagnosis character and treatment in recent years and to assess on the different treatment methods. DATA SOURCES： The relevant articles on the distal radioulnar joint injuries were searched for by using computer. ①The above mentioned articles published between January 2003 and April 2005 were searched for in （www.ncbi.nlm.nih.gov/PubMed） by using the key words “the distal radioulnar joint”; and limited the language to English.② Meanwhile, the articles published between January 1995 and December 2004 were also searched for in http：//www.wanfangdata.com.cn/ with the key words of “the distal radioulnar joint” and limited the language to Chinese. STUDY SELECTION： The included articles were those① Experimental studies; ②Clinical studies. Excluded articles were： ① Studies on tumor, deformity and degeneration in the distal radioulnar joint; ② Repetitive research literatures; ③Reviews. DATA EXTRACTION： Totally 141 articles related to the distal radioulnar joint in the aspects of anatomy, biomechanics, injured mechanism, diagnosis character and treatment were collected, among which 40 were focus on the quoted literatures and 101 were excluded. DATA SYNTHESIS： ① Anatomy and biomechanics： In order to keep normal biomechanies, the anatomic integrity of the distal radioulnar joint should be preserved in surgery operation;②Injured mechanism and diagnosis eharater： The careful examination to the injured forearm was very important, especially to the proximal and distal joints. We must be aware of the unstability of the distal radioulnar joint in the elbow injured patients. Some recent examination techniques would promote the early diagnostic accuracy;③Treatment： conservative treatment on the distal radioulnar joint injuries： Using forearm complete supination splinting to treat the dearticulation of back side of distal radioulnar joint （Ⅰtype dearticulation） with 36 cases, the effect was good; The operation treatment in early period： after manipulative reduction the deartieulation of distal radioulnar joint was fixed by rubber forceps directly. This kind of method had the advantages of small volume, fast fix, easy to operation; In the terminal stage salvage operations must be performed, including ulnar caitulum resection, Sauve-Kapandji operation, ligament transloeation reconstruction, periost of pronator quadratus muscle translocation operation, shortening ulnar or radius lengthening etc. Each operation had their advantages and disadvantages and adaptation, but the sequela was left more or less. The anatomic reconstruction should be conducted in the distal radioulnar joint. CONCLUSION： Clinical doctors should pay attentions to the distal radioulnar joint injuries. How to make effective early diagnosis and avoid the sequelae effectively will be the development direction of research from now on.