桡尺韧带关节内重建术治疗桡尺远侧关节陈旧性脱位

INTRA-ARTICULAR RADIOULNAR LIGAMENT RECONSTRUCTION FOR CHRONIC INSTABILITY OF DISTAL RADIOULNAR JOINT

目的总结桡尺韧带关节内重建术治疗桡尺远侧关节陈旧性脱位的疗效。方法2006年1月-2012年6月，采用桡尺韧带关节内重建术治疗桡尺远侧关节陈旧性脱位12例。其中男8例，女4例；年龄22～54岁，平均37.3岁。致伤原因：跌伤9例，交通事故伤2例，扭伤1例。病程2～13个月，平均6．2个月。采用腕关节功能患者自行评估量表（PRWE）对腕关节疼痛及功能进行评估，为（27．5±4．7）分。正位x线片均可见桡尺远侧间隙增宽，侧位片可见尺骨头向背侧脱位10例、向掌侧脱位2例；均无尺、桡骨骨折和桡尺远侧关节面退变。结果术后患者切口均I期愈合，无感染、神经损伤等手术早期相关并发症发生。12例均获随访，随访时间12～30个月，平均20．6个月。患者术前的腕关节酸痛无力、弹响症状均消失，手部握力恢复良好，前臂旋转及腕部活动功能恢复正常。末次随访时，应用PRWE对腕关节疼痛及功能进行评估，为（5．8±2．1）分，与术前比较差异有统计学意义（t=14．215，P=0．000）。X线片随访示，桡尺远侧关节对合良好，无明显脱位或半脱位。结论桡尺韧带关节内重建术可解剖重建桡尺远侧关节的稳定性，不破坏关节的邻近结构，术后功能恢复满意，是治疗不合并关节面退变的桡尺远侧关节陈旧性脱位的良好选择。

Objective To evaluate the effectiveness of intra-articular radioulnar ligament reconstruction in the treatment of chronic instability of the distal radioulnar joint. Methods Between January 2006 and June 2012, the intra- articular radioulnar ligament reconstruction was used to treat chronic instability of the distal radioulnar joint in 12 patients. Of 12 cases, 8 were males and 4 were females with an average age of 37.3 years （range, 22-54 years）. The causes of injury were tumble in 9 patients, traffic accident in 2 patients, and sprain in 1 patient. The average time from initial injury to operation was 6.2 months （range, 2-13 months）. The pain and function of the wrists were assessed with Patient-Rated Wrist Evaluation （PRWE） （27.5 ±4.7）. Broadening of the distal radioulnar joint space was seen on the anteroposterior radiograph in all the patients. Lateral view showed dorsal instability in 10 patients and palmar instability in 2 patients. There was no radial fracture, ulnar fractures or degeneration of the distal radioulnar joint. Results All patients achieved primary healing of incision. No complication of deep infection or nerve injury occurred. They were followed up from 12 to 30 months （mean, 20.6 months）. Pain and the clicking sound of the wrists disappeared; grip strength increased; the range of motion values of the wrist and forearm were restored. PRWE score was 5.8± 2.1 at last follow-up, showing significant difference when compared with preoperative score （t=14.215, P=0.000）. Imaging examination showed good appositions of the distal radioulnar joint, with no dislocation or subluxation. Conclusion Intra-articular radioulnar ligament reconstruction can rebuild the anatomic stability of the distal radioulnar joint, which does not damage the adjacent structures of the joints and can obtain satisfactory function of the reconstructed joint. It is a good choice for chronic instability of the distal radioulnar joint without articular degeneration.