Eiken O, Haga T, Sälgeback S
Scand J Plast Reconstr Surg. 1975;9(3):207-15. doi: 10.3109/02844317509022868.
A series of 314 wrist operations performed on 227 patients with rheumatoid arthritis is presented. In 266 hands various wrist operations were undertaken with the object of synovial debridement and in 48 hands the wrist was also arthrodesed. The mean age at the time of surgical treatment was 51 years and the mean period of observation 4.2 years. This study shows that the main benefits of synovectomy are related to a constant and marked pain relief and prevention of tendon ruptures. The hope that synovectomy might arrest or prevent skeletal destruction was not realized and progression of X-ray changes was found in 74%. The very low recurrence rate in the present series as judged by clinical signs is probably not very significant and it is concluded that the X-ray findings are the most reliable criteria reflecting the real activity in a rheumatoid joint. In several wrists where prophylactic ulnar head resection had been performed through a small ulnar incision, an active dorsal tenosynovitis with tendon invasion developed later. These and other findings at the operation indicate that the erosive effect of the distal end of the ulna is certainly not the sole cause of tendon rupture in this area and that a complete exposure and decompression of the tendons should regularly be performed. Finally, arthrodesis of the wrist was so successful that it can be highly recommended.
本文报告了对227例类风湿性关节炎患者进行的314例腕关节手术。在266只手中进行了各种旨在滑膜清创的腕关节手术，48只手同时进行了腕关节融合术。手术治疗时的平均年龄为51岁，平均观察期为4.2年。本研究表明，滑膜切除术的主要益处与持续且显著的疼痛缓解以及预防肌腱断裂有关。滑膜切除术可能阻止或预防骨骼破坏的希望并未实现，74%的患者出现了X线改变进展。根据临床体征判断，本系列中极低的复发率可能意义不大，得出的结论是，X线表现是反映类风湿关节真实活动的最可靠标准。在一些通过小尺侧切口进行预防性尺骨头切除的腕关节中，后来出现了伴有肌腱侵犯的活动性背侧腱鞘炎。手术中的这些及其他发现表明，尺骨远端的侵蚀作用肯定不是该区域肌腱断裂的唯一原因，应常规对肌腱进行完全暴露和减压。最后，腕关节融合术非常成功，强烈推荐使用。
