van Schoonhoven J, Kall S, Schober F, Prommersberger K-J, Lanz U
Klinik für Handchirurgie, Bad Neustadt/Saale, Germany.
Handchir Mikrochir Plast Chir. 2003 May;35(3):175-80. doi: 10.1055/s-2003-41980.
The arthrotically destroyed distal radioulnar joint will lead to painful limitation of forearm rotation. Alternative treatment options are the hemiresection-interposition arthroplasty or the Kapandji-Sauvé procedure. The aim of our study was to evaluate the clinical and functional results following the hemiresection-interposition arthroplasty in non-rheumatoid patients. The most common posttraumatic cause of the arthrosis was the malunited distal radius fracture. In a retrospective study we examined 36 of 51 patients with a mean age of 53 years after an average follow up of 34 months clinically, radiologically and using the DASH questionnaire. The average preoperative pain measured 7.8 on the visual analog scale and was reduced statistically highly significant (p < 0.01) to 3.9. Whilst pronation increased statistically not significantly from a mean of 74 degrees to 76 degrees (p = 0.428), supination improved significantly from 54 degrees to 69 degrees (p - 0.012). The average grip strength increased statistically highly significant (p<0.001) from 40% to 64% compared to the unaffected side. Patients' satisfaction with the result averaged 6.9 on a visual analog scale. Using a modified Mayo-wrist score, six patients were rated to have an excellent, eleven patients a good, ten patients a satisfactory and four patients a poor result. The average DASH score measured 35. In 21 patients radioulnar impingement was found. This appeared to be painful in 14 patients and required revision surgery using the ulnar head prosthesis in five patients. In three patients, secondary ulnar shortening had to be performed due to a remaining painful impaction of the distal ulna against the lunate and triquetrum. Comparing our clinical results with the reported results following the Kapandji-Sauvé procedure from the literature, there was no evident superiority of either of the procedures. There is a need for a functional evaluation following the Kapandji-Sauvé procedure to compare the remaining functional impairment following both procedures. In conclusion both procedures have to be classified salvage procedures and therefore the indication should be limited to the arthrotically destroyed distal radioulnar joint.
关节破坏的桡尺远侧关节会导致前臂旋转疼痛受限。替代治疗方案包括半切除-植入成形术或卡潘迪-索韦手术。我们研究的目的是评估非类风湿性患者行半切除-植入成形术后的临床和功能结果。关节病最常见的创伤后原因是桡骨远端骨折畸形愈合。在一项回顾性研究中，我们对51例患者中的36例进行了检查，这些患者平均年龄53岁，平均随访34个月，采用临床、放射学检查以及DASH问卷进行评估。术前平均视觉模拟量表疼痛评分为7.8分，统计学上显著降低（p < 0.01）至3.9分。旋前从平均74度增加到76度，统计学上无显著差异（p = 0.428），而旋后从54度显著改善到69度（p = 0.012）。与未受影响侧相比，平均握力统计学上显著提高（p<0.001），从40%提高到64%。患者对结果的满意度在视觉模拟量表上平均为6.9分。使用改良的梅奥腕关节评分，6例患者评为优秀，11例患者评为良好，10例患者评为满意，4例患者评为差。平均DASH评分为35分。在21例患者中发现了桡尺撞击。其中14例患者出现疼痛，5例患者需要使用尺骨头假体进行翻修手术。3例患者因尺骨远端持续疼痛性撞击月骨和三角骨而不得不进行二期尺骨短缩术。将我们的临床结果与文献中报道的卡潘迪-索韦手术后的结果进行比较，两种手术均无明显优势。需要对卡潘迪-索韦手术后进行功能评估，以比较两种手术后剩余的功能障碍。总之，两种手术都应归类为挽救性手术，因此适应证应仅限于关节破坏的桡尺远侧关节。
