Martini A K
Stiftung Orthopädische Klinik und Poliklinik, Universität Heidelberg.
Z Orthop Ihre Grenzgeb. 1992 May-Jun;130(3):175-80. doi: 10.1055/s-2008-1040135.
Partial arthrodesis of the carpus has again become a topical method. The technique has been improved and the range of indications has been extended. Fusion of certain areas has indeed been propagated as first-line therapy, for example in lunatum necrosis or as an important additional operation in substitution plastic surgery. Partial arthrodesis of the carpus is intended to eliminate mechanisms which has become pathological whilst preserving the best possible mobility. Partial arthrodesis alters the movement pattern of the individual ossae carpi. Moreover, the pressure in the adjacent joints also rises. The risk of a new pathological process is considerable. Recent publications report on a rapid development of impingement and symptoms. The most frequent partial arthrodeses are discussed. The indications and the direct consequences are critically analysed and explained with reference to examples. Technical details and potential dangers are described. An STT-arthrodesis is indicated for osteoarthritis of these bones. The radio-lunar arthrodesis is recommended for ulnar drifting of the carpus in cases of rheumatoid arthritis. Reconstruction of the central axis with arthrodesis of the capitate-lunate is indicated for pseudarthrosis of the scaphoid with carpal collapse. Other combinations are possible, they cause however greater functional deficits. We recommend a critical analysis of the function of the entire carpus before the operation. Caution is called for when an incipient arthrosis is present in the adjacent joint. Partial arthrodesis of the carpus is rather a temporary solution, since it enables time to be gained. Total arthrodesis is the ultimate resort.
腕关节部分融合术再次成为一种热门方法。该技术已得到改进，适应证范围也有所扩大。某些部位的融合确实已被推广为一线治疗方法，例如在月骨坏死时，或作为置换整形手术中的一项重要辅助手术。腕关节部分融合术旨在消除已发生病理改变的机制，同时尽可能保留最佳的活动度。腕关节部分融合术会改变腕骨个体的运动模式。此外，相邻关节的压力也会升高。出现新的病理过程的风险相当大。近期的出版物报道了撞击和症状的快速发展。文中讨论了最常见的部分融合术。结合实例对适应证和直接后果进行了批判性分析和解释。描述了技术细节和潜在风险。对于这些骨骼的骨关节炎，建议行舟大多角小多角关节融合术。对于类风湿性关节炎导致的腕关节尺侧偏移，推荐行桡月关节融合术。对于舟骨假关节伴腕骨塌陷，通过头月关节融合重建中心轴。其他组合也是可行的，然而它们会导致更大的功能缺陷。我们建议在手术前对整个腕关节的功能进行批判性分析。当相邻关节出现早期关节炎时需谨慎。腕关节部分融合术相当于是一种临时解决方案，因为它能争取时间。全腕关节融合术是最终手段。
