桡骨远端骨折后尺骨头习惯性掌侧脱位伴桡尺远端关节锁定,Medicine

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桡骨远端骨折后尺骨头习惯性掌侧脱位伴桡尺远端关节锁定
Medicine ( IF 1.3 ) Pub Date : 2020-07-17 , DOI: 10.1097/md.0000000000021343
Yuji Tomori _{1,

2} , Mitsuhiko Nanno ₃ , Shinro Takai ₃

Affiliation

补充数字内容可在文本摘要中获得：尺骨头习惯性掌侧脱位伴有锁定的远端桡尺关节 (DRUJ) 是桡骨远端骨折后罕见的并发症。我们介绍了一名患有背侧移位畸形桡骨远端骨折的女性尺骨头习惯性掌侧脱位的病例。患者疑虑：一名 72 岁的女性，在完全旋后时前臂偶尔会出现疼痛锁定。她在 6 个月前跌倒时左侧桡骨远端骨折。骨折已通过长臂和短臂石膏固定腕部非手术治疗 6 周。体格检查显示左手没有肿胀。前臂完全旋后时手腕锁定，并且通过将左尺骨向下压向 DRUJ，患者无法在不缩小尺骨的情况下使前臂旋前。在左前臂复位和旋前期间，她感到剧烈疼痛。与对侧手腕相比，受影响的手腕有 91% 的运动。诊断：X线片和计算机断层扫描显示桡骨远端背侧成角畸形愈合28°，尺骨头相对于桡骨半脱位。磁共振成像显示尺侧中央凹的尺侧三角纤维软骨复合体 (TFCC) 被破坏。干预：患者希望通过手术来解决左腕完全旋后时的疼痛咔哒声以及日常生活活动受限的问题。进行了桡骨远端的矫正截骨和TFCC尺侧撕裂的关节镜修复。TFCC 经关节镜修复至尺中央凹以稳定 DRUJ。结果：术后 1 年，X 线片显示桡骨完全愈合。与对侧手腕相比，患侧手腕活动度为 97%，前臂全方位旋转，无疼痛或咔哒声。与正常手腕相比，握力为100%。经验教训：畸形的桡骨远端骨折合并 TFCC 损伤可导致尺骨头的习惯性掌侧脱位，这是由于桡骨背侧严重成角畸形愈合和尺侧 TFCC 从尺中央凹撕脱。这种情况需要矫正截骨术和 TFCC 修复。TFCC 经关节镜修复至尺中央凹以稳定 DRUJ。结果：术后 1 年，X 线片显示桡骨完全愈合。与对侧手腕相比，患侧手腕活动度为 97%，前臂全方位旋转，无疼痛或咔哒声。与正常手腕相比，握力为100%。经验教训：畸形的桡骨远端骨折合并 TFCC 损伤可导致尺骨头的习惯性掌侧脱位，这是由于桡骨背侧严重成角畸形愈合和尺侧 TFCC 从尺中央凹撕脱。这种情况需要矫正截骨术和 TFCC 修复。TFCC 经关节镜修复至尺中央凹以稳定 DRUJ。结果：术后 1 年，X 线片显示桡骨完全愈合。与对侧手腕相比，患侧手腕活动度为 97%，前臂全方位旋转，无疼痛或咔哒声。与正常手腕相比，握力为100%。经验教训：畸形的桡骨远端骨折合并 TFCC 损伤可导致尺骨头的习惯性掌侧脱位，这是由于桡骨背侧严重成角畸形愈合和尺侧 TFCC 从尺中央凹撕脱。这种情况需要矫正截骨术和 TFCC 修复。与对侧手腕相比，患侧手腕活动度为 97%，前臂全方位旋转，无疼痛或咔哒声。与正常手腕相比，握力为100%。经验教训：畸形的桡骨远端骨折合并 TFCC 损伤可导致尺骨头的习惯性掌侧脱位，这是由于桡骨背侧严重成角畸形愈合和尺侧 TFCC 从尺中央凹撕脱。这种情况需要矫正截骨术和 TFCC 修复。与对侧手腕相比，患侧手腕活动度为 97%，前臂全方位旋转，无疼痛或咔哒声。与正常手腕相比，握力为100%。经验教训：畸形的桡骨远端骨折合并 TFCC 损伤可导致尺骨头的习惯性掌侧脱位，这是由于桡骨背侧严重成角畸形愈合和尺侧 TFCC 从尺中央凹撕脱。这种情况需要矫正截骨术和 TFCC 修复。由于桡骨背侧严重成角畸形愈合和尺侧TFCC从尺骨中央凹撕脱，畸形桡骨远端骨折合并TFCC损伤可导致尺骨头习惯性掌侧脱位。这种情况需要矫正截骨术和 TFCC 修复。由于桡骨背侧严重成角畸形愈合和尺侧TFCC从尺骨中央凹撕脱，畸形桡骨远端骨折合并TFCC损伤可导致尺骨头习惯性掌侧脱位。这种情况需要矫正截骨术和 TFCC 修复。

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Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint after distal radius fracture

Supplemental Digital Content is available in the text Abstract Rationale: Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture. Patient concerns: A 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist. Diagnosis: Radiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea. Interventions: The patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ. Outcomes: At 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist. Lessons: Malunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.

更新日期：2020-07-17

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