骨科英文书籍精读（134）｜尺侧腕关节损伤
ULNAR-SIDE WRIST INJURIES
(see also Chapter 16)
The distal radio-ulnar joint is often injured with a radial fracture; it can also be damaged in isolation, particularly after hyperpronation. The triangular fibrocartilage complex (TFCC) can be torn, the ulnar styloid avulsed or the articular surfaces of the ulnocarpal joint or distal radio-ulnar joint damaged.
Clinical features
There is tenderness over the distal radio-ulnar joint and pain on rotation of the forearm. The distal ulna may be unstable; the piano-key sign is elicited by holding the patient’s forearm pronated and pushing
sharply forwards on the head of the ulna.
Imaging and arthroscopy
A lateral x-ray in pronation and supination shows incongruity of the distal radio-ulnar joint. The anteroposterior view may show an avulsed ulnar styloid. Arthrography, MRI and arthroscopy may be needed to confirm the diagnosis.
Treatment
Instability usually resolves if the arm is held in supination for 6 weeks; occasionally a K-wire is needed to maintain the reduction. If the dislocation is irreducible, this may be due to trapped soft tissue, which
will have to be removed. Chronic instability may require reconstructive surgery.
A TFCC tear should be repaired and the ulnocarpal capsule reefed. A displaced fracture at the base of the ulnar styloid, if painful or associated with instability of the radio-ulnar joint, should be fixed with a small screw.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
hyperpronation 极度旋前（医学）
elicit /ɪˈlɪsɪt/vt. 抽出，引出；引起
supination /,sju:pi'neiʃən/n. 旋后；反掌姿势
incongruity /ˌɪnkənˈɡruːəti/n. 不协调；不一致；不适宜
Arthrography /ɑ:'θrɔɡrəfi/n. [特医] 关节照相术；[特医] 关节摄影术
arthroscopy /ɑr'θrɑskəpi/n. 关节镜检查；关节内视镜检查法
irreducible, /ˌɪrɪˈduːsəbl/adj. [数] 不可约的；不能削减的；不能复归的
reef /riːf/n. 暗礁；[地质] 矿脉；收帆vt. 收帆；缩帆
百度翻译：
尺侧腕关节损伤
（另见第16章）
桡尺骨远端关节常因桡骨骨折而受伤，也可单独受损，尤其是过度旋前后。三角纤维软骨复合体（TFCC）可撕裂、尺骨茎突撕脱、尺侧腕关节或桡尺远侧关节面损伤。
临床特征
桡尺关节远端有压痛，前臂旋转时疼痛。尺骨远端可能不稳定；保持患者前臂内旋并推压可诱发钢琴键征
在尺骨的头部急速向前移动。
影像学和关节镜检查
旋前和旋后的侧位x线片显示桡尺关节远端不协调。前后视图显示尺骨茎突撕裂。可能需要关节镜、核磁共振成像和关节镜检查来确认诊断。
治疗
如果手臂在仰卧位保持6周，不稳定性通常会得到解决；偶尔需要使用K形钢丝维持复位。如果脱位是无法复位的，这可能是由于软组织被困
必须移除。慢性不稳定可能需要重建手术。
TFCC撕裂应修复，尺骨腕关节囊重瓣。尺骨茎突基底部移位骨折，如果疼痛或伴有桡尺关节不稳，应使用小螺钉固定。