START TYPING AND PRESS ENTER TO SEARCH

冲击综合症：通过关节镜切除术去除尺骨疼痛

冲击综合症：通过关节镜切除术去除尺骨疼痛

17 五月, 2021

Síndrome de impactación cubital_04_20210513

然后，您可以通过手动翻译阅读此内容的相应英文翻译。 您也可以通过单击右上角的相应符号来查看西班牙语的原始文本。 通过此链接，您可以访问由Google翻译自动翻译的中文版本: https://bit.ly/3wiOHGV

The patient, 43, suffers from a combined ulnar impaction syndrome in his right wrist caused by the excess length of the ulna and ulnar styloid, which collide with the carpal area. More specifically, the head of the ulna surpasses the edge of the radius and impacts against the lunate bone and the styloid, bigger than normal, does so against the triquetrum.

Ulnar impaction syndrome
The combination of images above allows us to observe the main elements involved in the case under analysis. On the left radiograph we see how the head of the ulna is above the edge of the radius and the ulnar styloid has an abnormal size (the red line establishes the limit where the distal end of an ulna of normal length would be located). As noted in the body of the text, the excess length and size mentioned causes the head of the ulna to collide with the lunate bone and the styloid against the triquetral. On the other hand, in the MRI (on the right) the green circles indicate the aforementioned impact zones and the damage caused.

At the wrist, the ulna articulates with the radius – the so-called distal radioulnar joint – allowing hand and wrist rotation, that is, the movements of pronation (hand with the dorsum up) and its opposite, supination. In turn, it plays a prominent role as a load-bearing structure in these movements.

Positive ulnar variance or ulna plus, that’s to say, the ulna is longer than the radius at its distal ends, occurs in about 20% of the adult population. However, this characteristic becomes pathological, as in the case at hand, when the ulna repeatedly impacts on the ulnar carpal area.

The problem

Impaction syndrome causes pain in the patient on the ulnar side of the hand-wrist, as well as certain function problems. This degenerative pathology progressively degrades the triangular fibrocartilage and provokes bone damage to the lunate bone, due to its continuous collision with the head of the ulna and, in this case, also in the pyramidal one due to impacts with an abnormally sized ulnar styloid. Altogether, we find one of the pictures with several simultaneous injuries, common in a very complex area from an anatomical perspective.

Arthroscopy allows to visualize the degradation of the triangular fibrocartilage and the bone damage derived from the position of the head of the ulna and the ulnar styloid.

The goals

The clinical aims of Dr Piñal and his team focus on the elimination of ulnar pain and, by extension, the recovery of normal function in the affected limb.

The plan

Dr Piñal designs a procedure, based on his dry arthroscopy technique, to resect (cut) the ulna segment that exceeds the edge of the radius and the ulnar styloid fragment that impacts against the pyramidal bone, thus eliminating the two collision points.

Artrhoscopic resection
The image enables us to observe the arthroscopic resection of the head of the ulna and the ulnar styloid (right radiograph) and its difference in level with the initial situation, as shown in the central MRI and the left radiography (the green line is placed at the height of the styloid’s end prior to resecting and the red one at the position of a normal length ulna head). The tendon structure is preserved intact, without any functional alteration.
Pronosupination movement
Postoperative images show the patient performing a complete pronosupination movement.

The results

After surgery, the patient’s ulnar pain disappears and a complete recovery of movement is achieved.

患者证言：