韧带解剖重建术治疗慢性远尺桡关节不稳定

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1、窑52窑中华骨科杂志2012年1月第32卷第1期ChinJOrthop,January2012,Vol.32,No.1窑临床论著窑韧带解剖重建术治疗慢性远尺桡关节不稳定陈山林刘波童德迪荣艳波薛云皓田光磊揖摘要铱目的介绍自体掌长肌腱移植尧远尺桡韧带解剖重建的适应证尧手术方法及治疗慢性远尺桡关节渊distalradioulnarjoint袁DRUJ冤不稳定的初期随访结果遥方法2008年10月至2009年6月袁应用自体掌长肌腱移植尧远尺桡韧带解剖重建术治疗6例慢性DRUJ不稳定患者遥平均年龄22岁遥男4例袁女2例遥术中取腕背第四尧五伸肌鞘管间纵行切口遥切开鞘管袁显露DRUJ背侧部分遥横野L冶形切开

2、远尺桡背侧关节囊袁显露DRUJ和三角纤维软骨盘遥于桡骨远端尺背侧袁距离月骨窝和乙状切迹各约5mm处钻孔遥在尺侧腕屈肌腱桡侧做掌侧纵行切口袁切取全长掌长肌腱袁将其一端通过桡骨隧道穿至掌侧袁再用止血钳经三角纤维软骨盘下方透过掌侧关节囊袁将其引至背侧遥在尺骨颈和茎突隐窝之间钻孔遥将肌腱两个断端经尺骨隧道引至尺骨颈处袁再把其中一端绕过尺骨颈遥将前臂置于中立位袁抽紧缝合肌腱遥术后长臂石膏固定前臂于中立位遥4周后更换为前臂石膏袁继续制动4周遥结果所有患者术后均获得9耀24个月随访袁平均14个月遥术后没有感染及感觉神经支损伤等并发症遥疼痛减轻袁握力增加遥采用改良Mayo评分评估腕关节功能院术前平均69分袁

3、术后平均95分遥5例患者对手术结果满意遥结论韧带解剖重建术适用于无骨性关节炎的慢性DRUJ不稳定袁术后腕关节功能改善明显遥揖关键词铱桡腕关节曰关节不稳定性曰治疗结果揖证据等级铱治疗性研究郁级Anatomicreconstructionofthedistalradioulnarligamentsforchronicdistalradioulnarjointinsta鄄bilityCHENShan鄄lin,LIUBo,TONGDe鄄di,RONGYan鄄bo,XUEYun鄄hao,TIANGuang鄄lei.DepartmentofHandSurgery,JishuitanHospital,Be

4、ijing100035,China揖Abstract铱ObjectiveTointroducetheindicationsandoperativeprocedureofanatomicreconstruc鄄tionofthedistalradioulnarligamentsinpatientswithchronicinstabilityofthedistalradioulnarjoint(DRUJ),andreportitspreliminaryclinicalresults.MethodsFromOctober2008toJune2009,6patientswithin鄄stability

5、oftheDRUJunderwentanatomicalreconstructionusingafreepalmarislongustendongraft,includ鄄ing4malesand2femaleswithanaverageageof22years.A5cmdorsalincisionwasmadebetweenthefifthandsixthextensorcompartments.AnL鄄shapedflapwascreatedintheDRUJcapsule.Thisflapisthenelevatedproximallytoexposethearticularsurfac

6、eoftheDRUJandtheproximaltriangularfibularcartilagecomplex(TFCC).Atunnelwasmadethroughtheradius.Theothertunnelwasmadebetweentheulnarneckandthefoveaoftheulnarhead.Awhole鄄lengthpalmarislongustendongraftwastaken.Thevolaropeningoftheradiustunnelwasexposedthroughalongitudinalincisionradialtotheflexorcarp

7、iulnaristendon.Oneendofthegraftwaspulledtothepalmarsideeasilythroughthetunnel.AhemostatwaspenetratedthroughthevolarcapsuletothevolarsideproximaltotheremainingTFCC.Theendofthegraftwasgraspedwiththehemostatan