遠位橈尺関節不安定症の病態 : 急性及び亜急性6例の検討 Physiology of Acute and Subacute Distal Radioulnar Joint Instability

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著者

    • 安部 幸雄 ABE Yukio
    • 済生会下関総合病院整形外科 Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital
    • 藤井 謙三 FUJII Kenzo
    • 済生会下関総合病院整形外科 Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital

抄録

【はじめに】遠位橈尺関節(DRUJ)不安定症の成因はいまだ明らかでない.今回,自験例より損傷組織,病態は画一的でないことを確認したので報告する.【対象】症例は6例で全て男性,年齢は15歳~44歳,6例中5例は回外0~35度に制限され,1例では回外90度が可能であったが疼痛を訴えた.全例にX線,CT,MRI,関節鏡,直視下整復術を施行しその病態を検討した.【結果】損傷組織は尺骨茎状突起骨折5,偽関節1,背側遠位橈尺靱帯(RUL)―関節包間の断裂2,三角線維軟骨背側部断裂2,尺骨小窩からのRULの断裂2,DRUJ背側関節包の断裂1,背側RULの断裂1,尺側手根伸筋の掌側脱臼1であった.またCTにて尺骨頭の外旋転位を2例に認めた.【考察】DRUJ不安定症を呈する損傷様態は様々である.CTにて明らかな掌背側方向の転位がなくとも尺骨頭が橈骨に対し外旋転位することにより回外制限が生じるものと推察した.

The distal radioulnar joint (DRUJ) is a substantially unstable joint, and the dorsal and palmar radioulnar ligaments (RUL) are considered to play an important role for the stability. We investigated six cases of acute or subacute DRUJ instability. All were males which age ranged from 15 to 44 years (average: 23 years). Instability was examined using manual test, lateral X-ray of the wrist, and computed tomography (CT) including radio-ulnar line method and congruity method. Accompanied bone injuries were one Galeazzi fracture-dislocation, one perilunate transscaphoid fracture-dislocation, five ulnar styloid fractures, and one ulnar styloid non-union. <BR>Soft tissue injuries were variable: there were two lacerations between dorsal RUL and dorsal DRUJ capsule, two TFCC dorsal tears, two avulsions of RUL from the fovea, one laceration of dorsal DRUJ capsule, one tear of dorsal RUL, and one palmar dislocation of extensor carpi ulnaris tendon. There were two patterns of ulnar head instability. One was straightforward instability to the dorsal and the other was external rotational instability. Diagnosis using only the radio-ulnar line method is sometimes unreliable, thus total judgement including manual test, roentogenography, and congruity method in CT is necessary.

収録刊行物

  • 整形外科と災害外科

    整形外科と災害外科 55(3), 363-367, 2006-09-25

    West-Japanese Society of Orthopedics & Traumatology

参考文献:  6件中 1-6件 を表示

被引用文献:  3件中 1-3件 を表示

各種コード

  • NII論文ID(NAID)
    10018786812
  • NII書誌ID(NCID)
    AN00126582
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    00371033
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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