In Vivo Mechanical Function of the Distal Radial Ulnar Ligaments During Rotation of the Wrist.
In Vivo Mechanical Function of the Distal Radial Ulnar Ligaments During Rotation of the Wrist.
复制标题
腕部旋转过程中远端径向尺韧带的体内机械功能。
DOI：
10.1016/j.jhsa.2020.06.014
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Ruch DS
中科院分区：
文献类型：
--
作者：
Crowe MM;Martin JT;Grier AJ;Spritzer CE;Richard MJ;Ruch DS
本研究的目的是利用磁共振成像和双平面透视研究腕部非加权和加权旋转期间掌侧和背侧桡尺韧带（VRULs和drus）长度以及远端桡尺关节（DRUJ）间隙的变化。对7名正常成人志愿者的14个手腕进行成像，以确定drj的三维几何形状以及vrul和drul的浅层和深层束的插入位置。受试者在前臂旋转10个位置（从完全旋前到完全旋后）进行成像，有或没有5磅的重量。在每个位置测量浅、深VRUL和DRUL束的长度以及DRUJ空间（以毫米为单位），以评估韧带功能和DRUJ稳定性。在未加权和加权试验中，深部和浅层VRUL束的最大伸长发生在旋后，深部和浅层DRUL束的最大长度发生在旋前。最大的DRUJ空间出现在旋前，最小的出现在旋后30°。在加权试验中，在旋前30°和旋后30°之间的位置，VRUL深、浅束长度显著增加；然而，重量对药物长度没有影响。在加权试验中，在完全旋前和旋后15°之间的位置，drj空间显著增加。本研究证实了VRULs在旋后的伸长和DRULs在旋前的伸长。没有证据表明在DRUJ的背侧或掌侧有浅表/深韧带束的相互负荷。旋转时腕部负荷的影响主要在vrul组中表现明显，而在drul组中则不明显。在旋后约30°处，DRUJ空间最小。这些结果为有关三角纤维软骨复合体和DRUJ复杂生物力学的文献增加了信息。未来的工作应该评估三角纤维软骨复合体撕裂引起的生物力学变化，以确定撕裂的严重程度和位置与临床症状的关系。
The purpose of this study was to investigate changes in length of the volar and dorsal radioulnar ligaments (VRULs and DRULs), and the distal radioulnar joint (DRUJ) space during unweighted and weighted rotation of the wrist using magnetic resonance imaging and biplanar fluoroscopy. Fourteen wrists in 7 normal adult volunteers were imaged to define the 3-dimensional geometry of the DRUJ and the insertion sites of the superficial and deep bundles of the VRULs and DRULs. Subjects were imaged at 10 positions of forearm rotation ranging from full pronation to full supination, with or without a 5-pound weight. Lengths of the superficial and deep VRUL and DRUL bundles and DRUJ space were measured (in millimeters) at each position to evaluate ligament function and DRUJ stability. In the unweighted and weighted trials, maximal elongation of both deep and superficial VRUL bundles occurred in supination and maximal lengths of the deep and superficial DRUL bundles occurred in pronation. Maximum DRUJ space occurred during pronation and a minimum occurred in 30° of supination. In weighted trials, there was a significant increase in deep and superficial VRUL bundle length at positions between 30° of pronation and 30° of supination; however, there was no effect of weight on DRULs length. In weighted trials, there was a significant increase in DRUJ space at positions between full pronation and 15° of supination. This study demonstrates elongation of the VRULs in supination and the DRULs in pronation. There was no evidence of reciprocal loading of superficial/deep ligament bundles on either the dorsal or the volar aspects of the DRUJ. The effect of loading the wrist during rotation was apparent primarily in the VRULs, but not the DRULs. The DRUJ space was lowest at approximately 30° of supination. These results add information to the literature regarding the complicated biomechanics of the triangular fibrocartilage complex and DRUJ. Future work should evaluate changes in biomechanics caused by triangular fibrocartilage complex tears to determine how tear severity and location relate to clinical symptoms.
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