Alnot J Y, Fauroux L
Département de Chirurgie du membre supérieur, Centre Urgences Mains, Hôpital Bichat, Paris.
Rev Rhum Mal Osteoartic. 1992 Mar;59(3):196-206.
The authors studied a series of 104 rheumatoid wrists, stages II, III or IV according modified Larsen's grading, treated between 1980-1988 by synovectomy realignment stabilization. The mean follow-up period was 5 years. The operation presents different steps which have an additive effect and must be associated in order long term clinical and radiological stability. They associated: extensor tendons and articular synovectomy stabilization of the distal radio ulnar complex by Sauve-Kapandji's operation, tendon transfert: the extensor carpis radialis longus is transferred on the extensor carpi radialis brevis the extensor carpi ulnaris is relocated with posterior annular dorsal ligament plasty. Results concerning relief of pain were very clear because the patients presented either complete relief of pain (73%) or only intermittent occasional pain. The overall active range of motion is nearly the same, when compared pre- and post-operative ratings. In general the patients who presented good pre-operative mobility usually improved them and the others preserved them. Larsen's radiological grading was modified by the authors to include instability's criteria in frontal and sagittal plane. Carpal height remained stable (75% less than or equal to 1 mm), ulnar deviation has never overreached 3 mm, radial deviation was not modified in 50% of cases. They found only 4 wrists presenting a stage II radiological grading with an evolution to the stage III and 12 of the stage III grading became stage IV. The instable type of the stage IV was stabilized by a surgical radiolunate arthrodesis. The stabilized type was nearly not modified. The different steps of operation (articular and tenosynovectomy, carpus stabilization and realignment with stabilization by stabilization of the radio ulnar complex joint using Sauve-Kapandji operation, tendons transfers and dorsal retinacular plasty) have an additive effect in achieving relief of pain with preservation of the pre-existing mobility. The stabilization of the radio ulnar complex by the Sauve-Kapandji operation constitutes a new approach in rheumatoid arthritis published by the author in 1985 and in our opinion appears to be simple and is very efficient in stabilizing wrist immediately, thus allowing early rehabilitation of these patients. Long term stability is affirmed by clinical and roentgenologic follow-up and globally a painless wrist, a preservation of the pre-operative motion and a stabilization in frontal and sagittal plane is obtained.
作者研究了104例类风湿性腕关节，根据改良的拉森分级为II、III或IV期，于1980年至1988年间接受了滑膜切除复位稳定术治疗。平均随访期为5年。该手术包括不同步骤，这些步骤具有累加效应，必须联合实施以实现长期临床和放射学稳定性。它们包括：伸肌腱和关节滑膜切除；通过Sauve-Kapandji手术稳定桡尺远侧复合体；肌腱转移：桡侧腕长伸肌转移至桡侧腕短伸肌；尺侧腕伸肌重新定位并进行后环状背侧韧带成形术。关于疼痛缓解的结果非常明显，因为患者要么完全缓解疼痛（73%），要么仅偶尔出现间歇性疼痛。术前和术后评分相比，总体活动范围几乎相同。一般来说，术前活动度良好的患者通常会改善，而其他患者则保持原状。作者对拉森放射学分级进行了修改，以纳入额面和矢状面不稳定的标准。腕骨高度保持稳定（75%小于或等于1毫米），尺偏从未超过3毫米，50%的病例桡偏未改变。他们仅发现4例腕关节放射学分级为II期且进展至III期，12例III期分级进展为IV期。IV期的不稳定型通过手术桡月关节融合术得以稳定。稳定型几乎未改变。手术的不同步骤（关节和腱鞘切除、腕骨稳定以及通过使用Sauve-Kapandji手术稳定桡尺复合体关节进行复位和稳定、肌腱转移和背侧支持带成形术）在缓解疼痛并保留术前活动度方面具有累加效应。通过Sauve-Kapandji手术稳定桡尺复合体是作者于1985年发表的类风湿性关节炎的一种新方法，在我们看来，它似乎简单且在立即稳定腕关节方面非常有效，从而使这些患者能够早期康复。临床和放射学随访证实了长期稳定性，总体上获得了无痛的腕关节、术前活动度的保留以及额面和矢状面的稳定。
