Diagnosis and anatomic reconstruction of extensor carpi ulnaris subluxation
Diagnosis and anatomic reconstruction of extensor carpi ulnaris subluxation
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DOI：
10.1016/j.jhsa.2007.10.002
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发表时间：
2008-01-01
影响因子：
1.9
通讯作者：
Trumble, Thomas E.
中科院分区：
文献类型：
--
作者：
MacLennan, Allison J.;Nemechek, Nicholas M.;Trumble, Thomas E.
目的评价动态超声诊断尺侧腕伸肌（ECU）半脱位的有效性和一种新的解剖型ECU腱鞘重建技术的效果。方法应用动态超声诊断以旋后、旋前时尺腕弹响疼痛为主要表现的ECU肌腱半脱位。21例持续性半脱位患者使用新技术重建ECU腱鞘。在这个过程中，ECU肌腱在其鞘内背侧和径向升高。用电动钻加深远端尺骨沟，沿重建沟的尺骨缘沿着放置2或3个带线锚钉。缝线穿过ECU鞘的尺骨边缘并打结，将腱鞘固定到骨上。在前瞻性研究中，记录术前腕关节屈曲-伸展、桡尺偏、旋前-旋后、握力、疼痛评分、满意度和臂、肩和手残疾（DASH）评分，并与术后值进行比较。14例男性患者和7例女性患者术后随访24至45个月（平均31个月）。结果21例患者均经腕关节动态超声证实为症状性ECU肌腱半脱位。我们注意到重建后腕关节屈曲-伸展、桡尺偏、旋前-旋后和握力的弧度在统计学上显著增加。ECU稳定后，疼痛、满意度和DASH评分有统计学显着改善。结论动态超声是诊断ECU肌腱半脱位的一种有效、无创的方法，我们的解剖ECU腱鞘重建技术改善了术后腕关节活动度、握力、疼痛、满意度和DASH评分。
Purpose To evaluate the efficacy of dynamic ultrasound to diagnose extensor carpi ulnaris (ECU) subluxation and assess the results of a new technique for anatomic ECU tendon sheath reconstruction. Methods Dynamic ultrasound was used to confirm the diagnosis of ECU tendon subluxation in patients presenting with painful snapping of the ulnar wrist during supination and pronation. Twenty-one patients with persistent subluxation had reconstruction of the ECU tendon sheath using a new technique. In this procedure, the ECU tendon is elevated within its sheath dorsally and radially. The distal ulnar groove is deepened with a power burr, and 2 or 3 suture anchors are placed along the ulnar margin of the reconstructed groove. The sutures are passed through the ulnar border of the ECU sheath and tied, securing tendon sheath to bone. Preoperative wrist flexion-extension, radial-ulnar deviation, pronation-supination, grip strength, and ratings of pain, satisfaction, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were recorded and compared with postoperative values in a prospective study. Fourteen male patients and seven female patients were followed from 24 to 45 months postoperatively (mean, 31 mo). Results Twenty-one patients presented with symptomatic ECU tendon subluxation confirmed by dynamic ultrasound of the wrist. We noted a statistically significant increase in arc of wrist flexion-extension, radial-ulnar deviation, pronation-supination, and grip strength after reconstruction. There was a statistically significant improvement in pain, satisfaction, and DASH scores after ECU stabilization. Conclusions Dynamic ultrasound is an effective and noninvasive method of diagnosing ECU tendon subluxation, Our technique of anatomic ECU tendon sheath reconstruction improved postoperative wrist range of motion, grip strength, pain, satisfaction, and DASH scores.