摘要目的 探讨尺腕关节游离体的临床特点和治疗方法.方法 2006年1月至2011年1月,共收治6例(7侧)尺腕关节游离体患者,其中累及左腕5侧,右腕2侧.主要症状为慢性腕尺侧疼痛,伴腕尺偏、背伸及旋转活动受限.影像学检查显示尺骨茎突远端桡掌侧有一个或数个圆形或卵圆形游离体,伴局部滑膜组织增生.均采用腕关节切开、游离体及病变滑膜切除术治疗.1例合并尺腕撞击综合征患者,同时行尺骨短缩术.术后固定腕关节旋后、尺偏位4周.病理结果显示滑膜组织软骨化生.结果 6例均获得随访,平均随访时间为25个月.术后所有患者腕关节尺侧疼痛缓解,关节活动度恢复正常,按照Cooney腕关节评分标准评定:优6侧,良1侧.结论 尺腕关节游离体的形成是滑膜组织软骨化生,化生的软骨进一步增殖、骨化和钙化的结果.其腕尺侧疼痛症状是由于游离体卡在尺骨茎突和三角骨之间,造成机械性撞击及病变滑膜侵犯周围组织导致.采用关节切开游离体及病变滑膜切除术治疗,创伤小,疗效好.

abstractsObjective To investigate the clinical characteristics and treatment of loose bodies in the ulnocarpal joint. Methods Six patients(7 wrists,5 on the left side and 2 on the right side) who were diagnosed with loose bodies in the ulnocarpal joint were treated from January 2006 to January 2011.The main complaint was chronic ulnar-sided wrist pain,with limitation of wrist extension,ulnar deviation and rotation.Radiographic examinations revealed single or multiple round or oval calcifications at the radial-palmar side of the ulnar styloid,with synovium proliferation.All the patients were treated with removal of loose bodies and synovectomy by arthrotomy.Ulna of one patient who was also diagnosed with ulnocarpal impaction syndrome was shortened simultaneously.Postoperatively the wrists were immobilized by plaster at the supination and ulnar deviation position for four weeks.The pathologic findings showed chondral metaplasia in the involved synovium.Results All patients were follow-up with a mean follow-up time of 25 months.The pain was relieved in all cases without any surgical complications.The range of motion of the wrist returned to normal.According to Cooney's modified wrist scoring system,excellent results were recorded in six wrists and good in one. Conclusion Formation of loose bodies in the ulnocarpal joints was the result of synovial chondrometaplasia,and calcification and ossification of the proliferated chondrocytes.The symptom of ulnar-sided wrist pain was mainly caused by the impingement of loose bodies between the ulnar styloid and triquetrum during wrist extension and ulnar deviation,and also by invasion of the lesional synovium to surrounding tissues.Removal of loose bodies and synovectomy by arthrotomy was the right choice of treatment to achieve satisfactory effect.