Hülsbergen-Krüger S, Partecke B
Abteilung für Handchirurgie, Plastische und Mikrochirurgie, Zentrum für Schwerbrandverletzte, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg.
Orthopade. 1999 Oct;28(10):899-906.
Indications for intercarpal and radiocarpal resectionarthroplasty and fusions are osteoarthritis, KIEHNBOCK'S disease, rheumatoid arthritis and several posttraumatic disorders of the wrist joint. The resection of carpal bones leads to severe instability patterns of the wrist. In conclusion we recommend resection-arthroplasty just for treatment of the thumb carpo-metacarpal osteoarthritis. Implant resection arthroplasty of the lunate and scaphoid or total wrist implants are still causing multiple problems regarding heavy load. Therefore this implants should be confined to rheumatoid patients. Of the limited carpal arthrodeses the scaphotrapezium-trapezoid arthrodeses is the most frequent performed procedure. It can be indicated for STT-osteoarthritis, KIEHNBOCK's disease, scapho-lunate instability and scaphoid pseudarthrosis if other surgical procedures had failed presuming there are no signs of arthrosis in the radiocarpal joint. Persisting pain especially in heavy work is quite frequent after limited arthrodesis but can be greatly relieved by simultaneous wrist denervation. In advanced cases of osteoarthritis total wrist arthrodesis is still the best choice for the patient.
腕骨间和桡腕关节切除成形术及融合术的适应证包括骨关节炎、月骨无菌性坏死、类风湿关节炎以及几种腕关节创伤后疾病。腕骨切除会导致腕关节严重不稳定。总之，我们建议仅将切除成形术用于治疗拇指腕掌关节骨关节炎。月骨和舟骨的植入物切除成形术或全腕植入物在承受重负荷方面仍存在诸多问题。因此，这些植入物应仅限于类风湿患者使用。在有限的腕骨融合术中，舟大多角小多角骨融合术是最常施行的手术。如果其他手术方法失败，且桡腕关节无关节炎迹象，对于舟大多角小多角骨骨关节炎、月骨无菌性坏死、舟月骨不稳定和舟骨假关节，它都可作为适应证。在有限融合术后，持续疼痛尤其是在重体力劳动时相当常见，但同时进行腕部去神经支配可大大缓解疼痛。在骨关节炎晚期病例中，全腕关节融合术仍是患者的最佳选择。
