下尺桡关节不稳诊断和治疗进展

下尺桡关节不稳如何处理是目前骨科和手外科医生非常关注的问题.下尺桡关节属滑车关节,关节面不完全匹配,需要韧带和肌肉等软组织结构维持其稳定性.下尺桡关节不稳的总类繁多,诊断和治疗方法复杂,疗效不确切.诊断上可经X线摄片、CT明确骨性损伤,经MRI、关节镜等明确软组织,特别是TFCC损伤.对急性下尺桡关节不稳,大部分可采用保守治疗;对TFCC损伤,可采用手术切开或关节镜治疗;对伴有尺骨茎突骨折的桡骨远端骨折不稳,可使用张力带钢丝固定治疗;对慢性下尺桡关节不稳,可采用软组织重建术;对尺骨头缺失所致不稳,可采用人工关节置换术.     

上下尺桡关节损伤的诊断与治疗

前臂损伤是临床上常见的损伤,同时伴上尺桡关节脱位或下尺桡关节脱位也比较常见,但伴上下尺桡关节同时损伤(如Essex-Lopresti骨折-脱位)较少见,常发生漏诊及误治。笔者自1997年12月～2007年1月收治的26例前臂损伤伴尺桡关节脱位,现对该损伤的发生机制、诊断和治疗进行探讨。1临     

桡尺远侧关节损伤类型及诊治近况

桡尺远侧关节损伤类型及诊治近况谭忠奎综述陈庄洪审校桡尺远侧关节损伤在日常生活中并非少见，然而，如果对此认识不足，往往会导致诊断及治疗上的错误，势必造成桡尺远侧关节功能障碍和产生其它并发症。近年来，随着人们对该关节认识的增加，提高了桡尺远侧关节损伤的诊...     

下尺桡关节不稳的诊断与治疗进展

下尺桡关节的复杂解剖结构是其实现前臂旋转功能和力量传导的基础。下尺桡关节不稳分为原发性不稳、创伤后或术后不稳。结合病史、体格检查与影像学表现对下尺桡关节不稳进行分型有助于病情的诊治。下尺桡关节不稳的治疗方法有保守治疗和手术治疗。     

尺骨矫形术在下尺桡关节损伤后期治疗中的应用

对于骨科或手外科医师而言,下尺桡关节损伤的后期治疗仍是棘手的难题。对下尺桡关节损伤缺乏足够的认识和相应的早期处理是该关节在各种创伤后产生慢性疾惠的主要原因。在病因学分类中,桡骨远端骨折的畸形愈合是引起下尺桡关节创伤后慢性疾患的首要原因。下尺桡关节损伤的后期治疗旨在改善腕部功能和减轻肢体疼痛。近年来,关于各种尺骨矫形术在下尺桡关节损伤后期治疗中应用的报道日益增多,该文就其中的一些进展作一综述。     

桡尺远侧关节损伤及诊治现状

根据近年来相关文献,从桡尺远侧关节解剖、生物力学、损伤类型、致伤机制及诊治现状作一概述,以期充分认识桡尺远侧关节及损伤特点,从而准确诊断与及时正确地处理,以获得满意的疗效。     

陈旧性下尺桡关节脱位的治疗

目的介绍陈旧性下尺桡关节脱位的治疗方法及效果。方法对11例陈旧性下尺桡关节脱位,采用旋前方肌骨膜瓣移位术及尺骨节段截除术使下尺桡关节复位。结果术后随访1~24个月,前臂旋转功能、腕关节活动度恢复满意,X线片示下尺桡关节对位关系正常。结论对不同下尺桡关节陈旧性脱位治疗采用不同术式,分别治疗,才能获得良好效果。     

单纯远侧桡尺关节脱位诊治体会

单纯远侧桡尺关节脱位比较常见,但文献报道较少,如果对这类损伤认识不足,往往会导致诊断及治疗失误,势必造成患者慢性持续的腕痛,手和前臂活动受限及桡尺远侧关节不稳,近年来,我们采用手法复位长臂石膏固定治疗单纯远侧桡尺关节脱位,取得满意效果。笔者总结了1998年1月-2003年12月治疗的128例患者,现报道如下。     

The distal radioulnar joint

Reconstructive surgery of the distal radioulnar joint should be considered for those in the age range of 20 to 50 years, particularly in those patients having sustained a high-energy injury and in cases where there is a great demand on the wrist joint for heavy work and sports activities. Meticulous preoperative planning in terms of correct clinical and radiologic evaluation and strict adherence to restoration of the joint congruency and restoration of ligament function are most important in obtaining reliable, long-term results in the vast majority of patients.     

下尺桡脱位合并桡骨头脱位的诊断与治疗

目的探讨下尺桡脱位合并桡骨头脱位的的诊断和治疗。方法本文报道的2个典型病例,一例是下尺桡背侧脱位同时合并桡骨头后脱位,另一例是下尺桡掌侧脱位合并桡骨头前脱位,均不合并尺桡骨干的骨折。用单纯桡骨头脱位或下尺桡脱位的机制不能很好地解释。对于急性损伤,应先在麻醉下试行闭合复位,如不成功可考虑切开复位。结果根据目前研究,“绞锁损伤”的机制能比较好得解释这种损伤,骨间膜在前臂两骨之间起到一个“枢轴”的作用。早期诊断和治疗能达到良好的效果。结论早期诊断和早期复位固定非常重要,需要和孟氏骨折、盖氏骨折或Essex—Lopresti损伤等相鉴别。     

The distal radioulnar joint.

A phylogenic review shows the DRUJ to be a highly evolved and specialized structure. The diarthrodial joint, in combination with the TFCC, ligament complex, and oblique fibers of the distal interosseous membrane, permit rotation while preserving stability and transmitting the load borne by the radiocarpal joint to both bones of the forearm. Our improved, yet imperfect, understanding of the anatomy, biomechanics, and pathophysiology of the region, abetted by new imaging modalities and wrist arthroscopy, permit more precise diagnosis and thus more rational treatment. The persistent inconsistency of our results belies our imperfect comprehension. Thus humbled, consider Goethe's admonition as a call to further scrutiny and investigation, "Theory and experience are opposed to each other in constant conflict. Only action can reconcile them."     

Imaging the distal radioulnar joint

Imaging the DRUJ requires knowledge of the complex bony, muscular, and ligamentous anatomy that contribute to this unique joint. Standard well-positioned radiography is always the appropriate first step in any imaging evaluation of the wrist. High-resolution MRI of the wrist, preferably performed at 3T, helps to delineate the important ligamentous structures relevant to the DRUJ and ulnar wrist, whether the joint is unstable or not. The presence of instability on physical examination is an indication for dynamic CT evaluation. Close attention to technique, no matter what the modality of choice, offers the best chance for success in providing added value with imaging. Finally, communication between the radiologist and hand surgeon allows the advanced imaging examinations to be tailored to the specific clinical problem for the most effective use of resources for each individual patient.     

不固定下尺桡关节治疗桡骨远端骨折合并下尺桡关节不稳定的病例对照研究

目的：探讨桡骨远端骨折合并下尺桡关节不稳的治疗方式。方法：2007年6月至2009年12月,采取切开复位内固定治疗不稳定型桡骨远端骨折264例,其中42例术中发现合并下尺桡关节不稳,20例采取克氏针固定下尺桡关节或旋后位石膏外固定治疗（固定组）,22例未行固定（非固定组）。术后对握力和腕关节活动范围进行观察;采用Sarmiento改良的Gaaland-WeAey评分系统（GW评分）对腕部功能进行评估,并测试下尺桡关节稳定性。结果：41例患者均获得1年以上随访,所有患者桡骨远端骨折均在术后3个月内获得愈合,下尺桡关节均对合良好,没有出现明显半脱位或脱位。两组患者的握力、腕关节活动范围及GW评分差异无统计学意义（P〉0．05）。l例发生远期下尺桡关节不稳。结论：对桡骨远端骨折合并下尺桡关节不稳定采用锁定钢板固定系统治疗桡骨远端骨折的同时,固定与不固定下尺桡关节临床效果无差异,因此对于合并下尺桡关节不稳的桡骨远端骨折,若桡骨远端骨折能获得满意的解剖复位,不推荐l期固定下尺桡关节。     

Classification of distal radioulnar joint disorders

The wrist is one of the most complex articulations in the human body. The distal radioulnar joint (DRUJ) is particularly controversial, enduring as the area least understood with regard to anatomy and pathomechanics. The popular systems of classifying DRUJ disorders are based on etiology and treatment, but this approach has inspired schemes that are cumbersome, redundant, and incomplete. The need for an improved system prompted us to devise a simplified system that is based on the pathomechanics of dysfunction and the mechanical requirements for optimal joint function.     

Kinematics of the distal radioulnar joint

The kinematics of the normal distal radioulnar joint (DRUJ) in five fresh frozen cadavers were investigated by means of computerized tomography (CT). Rotation of the radius about the ulna is accompanied by translation so that in supination the ulna is somewhat palmar, and in pronation the ulna is more dorsal relative to the radius. The average ranges of motion of the hand and DRUJ were 260 degrees and 190 degrees, respectively. Significant carpal and metacarpal rotation occurred with pronation-supination of the hand. The DRUJ has both rotational and translational components of movement and does not have a single center of rotation. The pathway of the instantaneous centers of rotation, or centrode, of the DRUJ has a characteristic pattern. The centrode moves in a direction opposite that of the DRUJ movement and is located near the center of the ulnar head. A prosthetic joint for the DRUJ should not have a fixed axis of rotation but should allow the normal translatory motion of the ulna and radius if early joint failure is to be prevented.