{"title":"修复三角纤维软骨复合体撕脱的蜂窝状附着物的腕骨开窗法","authors":"","doi":"10.1016/j.jhsa.2022.10.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p><span>To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid </span>osteotomy, and to assess its clinical results.</p></div><div><h3>Methods</h3><p><span><span>We reviewed 12 patients with distal radioulnar joint<span> (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments<span>. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor </span></span></span>carpi<span> ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ </span></span>subluxation, and any hardware-related problems.</p></div><div><h3>Results</h3><p>Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity<span><span>, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the </span>ulnar nerve.</span></p></div><div><h3>Conclusions</h3><p>Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Styloid Ulna Window Approach for Repair of Avulsed Foveal Attachment of Triangular Fibrocartilage Complex\",\"authors\":\"\",\"doi\":\"10.1016/j.jhsa.2022.10.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p><span>To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid </span>osteotomy, and to assess its clinical results.</p></div><div><h3>Methods</h3><p><span><span>We reviewed 12 patients with distal radioulnar joint<span> (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments<span>. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor </span></span></span>carpi<span> ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ </span></span>subluxation, and any hardware-related problems.</p></div><div><h3>Results</h3><p>Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity<span><span>, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the </span>ulnar nerve.</span></p></div><div><h3>Conclusions</h3><p>Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p></div>\",\"PeriodicalId\":54815,\"journal\":{\"name\":\"Journal of Hand Surgery-American Volume\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery-American Volume\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0363502322006116\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0363502322006116","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的:描述一种通过尺骨肩胛骨截骨术开放性修复三角纤维软骨复合体窝撕脱的手术方法,并评估其临床效果:方法:我们对12例因DRUJ韧带孤立性窝状撕脱而导致远端放射性肘关节(DRUJ)不稳定的患者进行了回顾性研究。所有患者均接受了腕关节镜检查,以排除三角纤维软骨复合体表层撕裂的并发症,并通过阳性钩试验确诊。在图像增强仪的控制下,通过尺骨屈肌和尺骨伸肌之间的尺侧入路,在尺骨头窝的尺侧进行了尺骨样式骨截骨。通过从尺骨窝到尺骨颈的经骨缝合固定撕脱的尺骨窝附件。通过螺钉或张力带钢丝固定尺骨基台。结果测量包括疼痛(视觉模拟量表)、握力、DRUJ不稳定性、腕关节活动范围和改良梅奥腕关节评分的临床评估。放射学评估用于确定尺骨髁截骨的结合情况、DRUJ半脱位以及任何与硬件相关的问题:平均随访 21 个月后对结果进行评估。所有病例的截骨都在 11 周前愈合。DRUJ松弛度、视觉模拟量表和改良梅奥腕关节评分均有所改善,而握力和活动范围保持不变。有一名患者的硬件突出,需要在截骨结合后拆除。没有尺神经背皮支损伤或神经瘫痪的病例报告:结论:使用尺骨式截骨术对三角纤维软骨复合体撕脱的窝状附着物进行开放式修复,是开放式或关节镜修复方法的一种替代方法:治疗 IV.
Styloid Ulna Window Approach for Repair of Avulsed Foveal Attachment of Triangular Fibrocartilage Complex
Purpose
To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results.
Methods
We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems.
Results
Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the ulnar nerve.
Conclusions
Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches.
期刊介绍:
The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.