Comparative Study Of Operation Of Ulnar Impingement Syndrome With Different Operative Methods

Objective: Wrist is the most important joint to maintain function of thehand, and deformity or pathological changes of the wrist will affect functionof the hand. Wrist will made the hand stability and synergy. the rotary of thewrist itself is very limited, the rotation of the hand is completed by the rotationof the forearm.About66%of the movement of the wrist is took place by theradiocarpal joint while it stretches; about40%of the movement of the wrist istook place by the radiocarpal joint while it buckes; about40%of themovement of the wrist is took place by the radiocarpal joint while it widesradial. about90%of the rotation of the hand is completed by the radiocarpaljoint, only10%of the movement is took place in the radiocarpal and wristjoints［1］. Distal radial fractures is very common, accounting for about17%ofall emergency fracture［20］. Because of the lack of treatment or treatmentmeasures undeserved, the phenomenon of the ulnar longer and the radialshorter will be seen or ulnar impingement syndrome［10］Can be seen becauseof the subsequent injury of the radiocarpal joint.In recent years, it is reportedthat the operation of mouse and keyboard may cause Ulnar impingementsyndrome［14］［15］. With the level of doctor's diagnosis raising and the advancedmedical equipment applications［16］［17］［18］, its incidence also is rising.Ulnar impingement syndrome influences the function of distalradioulnar joints and the radiocarpal joint seriously, and affectes functions ofthe hand. Although disease of the distal radioulnar joint is paied attention toearly, but the joint is still not be researched completely, reliable treatmentmethods of many of the disease to this joint is still not be found. Ulnarimpingement syndrome is caused by the impaction of the wrist bones andulnar, the early changes is cartilage and bone marrow change edema,theterminal is osteonecrosis and osteoarthritis,which can cause serious obstacle function, affect the person's life, work and study. Early diagnosis andtreatment can reduce morbidity, improve the quality of the patients' lifeobviously.in china and abroad studies of this are less recently, understandingof clinical and radial doctor is not enough obviously.This study aims toevaluate the clinical outcomes of different operative methods to treat ulnarimpingement syndrome, and to complete biomechanics analysis, to find thebest way of operation and its indications by biomechanics analysis of the threeoperative methods,to prevent secondary pain and dysfunction.Method:From2007to2011years,19patients of ulnar impingementsyndrome were used respectively by Darrach osteotomy (7cases), theSauve-Kapandji osteotomy (7cases), ulnar shortenin osteotomy (5cases),werebe followed up to rate the function by function evaluation standard［1］of thewrist. On the basis of the comparison of procedures of three kinds,the wristjoint function could be evaluated. Then24cases of fresh upper limbspecimens were divided into four group randomly. Group A: control group;Group B: ulnar shortenin osteotomy group; Group C: the Sauve-Kapandjiosteotomy group; Group D:the Darrach osteotomy group. By the CSS-44020series biomechanical machine, Pressure Sensitive Film were put into the wristjoint radius and articular surface respectively.With homemade experimentalframe upper limb specimens were fixed, keeping the wrist joint neutral potion.5N/s pressure were put on the wrist joint speedding to200N andmaintainning60s.Then each group of Pressure Sensitive Film were measured.The result of Pressure Sensitive Film was analysed with SPSS software.Results:19patients were be followed up from2to23months, average11.3months. The wounds heal well without infection. Because indications ofthem are different,they can't be compared simply with statisticalsoftware.Biological experimental:With pressure by average, the structuralarea and the forces of the ulnar joint surface, the shorter of the ulnarosteotomy,the Sauve-Kapandji osteotomy and control group are in turnincreased. Nest of scaphoideum and lunate bone and articular surface of radiuson stress, the structural area,the average pressure and stress area, force of the total size of the control group,the Sauve-Kapandji osteotomy, the ulnarshortenin osteotomy,the Darrach osteotomy are in turn increased.Conclusion:To treat ulnar impingement syndrome, the treatment surgerycan improve the function of patients' wrist,reduce the pain of patients,andmost of the symptoms were improved obviously. But the surgical treatment ofpain was not exactly. By biomechanical study analysis,the shorter of the ulnarosteotomy is superior to the Sauve-Kapandji osteotomy and the Darrachosteotomy, payying attention to the length of the interception of ulnar.