键盘鼠标操作引起尺骨撞击综合征的诊断及原因

目的探讨键盘鼠标操作引起腕部尺骨撞击综合征的诊断及诱因。方法采用宋海涛等的尺骨撞击综合征诊断标准，总结2004年12月至2007年12月，长时间操作键盘鼠标后诱发尺侧腕痛人员102例，利用物理检查及影像学检查，分析操作键盘鼠标引起尺骨撞击综合征的原因。结果33例诊断为尺侧撞击综合征，尺骨阳性变异13例（39．3％），尺骨动态阳性变异10例（66．7％）；14例（100．0％）出现腕骨MRI信号改变，信号改位于月骨尺侧部分近端、三角骨腰部和底部，以及尺骨头桡侧近端；13例（92．9％）出现三角纤维软骨损伤，部位多在尺侧及中央部（76．9％）；随着操作键盘鼠标时间的延长，腕部尺侧疼痛、握力下降等症状逐渐加重，Chun和Palmar腕部功能评分明显降低。结论长时间操作键盘鼠标，加剧或诱发尺骨动态阳性，导致尺骨头密集地撞击TFC和腕骨，造成尺骨撞击综合征；联合临床症状、物理检查及影像学检查能早期诊断计算机操作引起的尺骨撞击综合征。

The diagnosis and reasons of ulnar impaction syndrome caused by manipulating of keyboard and mouse

Objective To explore the diagnosis and reasons of carpal ulnar impaction syndrome caused by manipulating of keyboard and mouse. Methods From December 2004 to December 2007, adopting Song＇s diagnostic criteria of ulnar impaction syndrome, 33 of 102 cases who operated computer for long time everyday and complained of ulnar wrist pain were diagnosed of ulnar impaetion syndrome. Physical examination and image check of injured wrist were taken to analyze and search for what led to ulnar impaction syndrome for those people. Results Thirteen cases of ulnar impaction syndrome have positive ulnar variance （39. 3% ）. Dynamic positive ulnar variance could be evoked in ten cases （66.7%. Abnormal MRI signal intensity of carpal were found in 13 cases（92.9% ） and the sites of signal alteration located at ulnar side of lunate or（and） at the waist and bottom of triquetrum, and the proximal radialis of head of ulna. Thirteen wrists（92. 9% ） were found to have triangular fibrocartilage（TFC） injury at the ulnar side or （and） the central parts. Ulnar carpal pain aggravated and grip strength descended gradually along with the prolongation of continuous operating keyboard and mouse everyday, while the scores of Chun and Palmar＇s wrist function degraded markedly. Conclusion Ulnar impaction syndrome could be induced by repeated wrist joint ulnar deviating and pronating, which could provocate carpal dynamic positive ulnar variance and resulted in head of ulna impacting TFC and carpal bone at last. Early diagnosis of ulnar impaction syndrome can be made by combining clinical symptom, physical examination and imaging check.