Lee Steve K, Gargano Francesco, Hausman Michael R
New York University Hospital for Joint Diseases Orthopaedics Institute, The New York University School of Medicine, New York, NY 10003, USA.
Hand Clin. 2006 Nov;22(4):529-38; abstract vii. doi: 10.1016/j.hcl.2006.09.002.
Wrist arthrofibrosis is a condition of decreased range of wrist motion due to intrinsic adhesions and extrinsic contracture. It is clinically characterized by restricted wrist range of motion, pain, swelling, and a plateau in improvement after at least 6 months of intensive physiotherapy. Other conditions must be excluded, such as articular incongruity, arthritis, spasticity, skin and subcutaneous scarring, and loose bodies. We have devised a classification system based on pathologic anatomic location, where Type I represents intrinsic adhesions, and Type II represents extrinsic contracture. The types are subdivided according to where the pathology is present. The operative approach should be wrist arthroscopy for Types IA (radiocarpal adhesions) and IB (midcarpal adhesions) where intraarticular adhesions are present. Types IC (distal radioulnar joint adhesions) and II C (distal radioulnar joint capsular contracture) are best approached in an open manner where dorsal and palmar capsulectomies of the distal radioulnar joint are performed. For Types IIA, B, and D (dorsal, palmar, and combination extrinsic contracture, respectively), both open and arthroscopic methods are described.
腕关节纤维性强直是一种由于内在粘连和外在挛缩导致腕关节活动范围减小的病症。其临床特征为腕关节活动范围受限、疼痛、肿胀，以及在至少6个月的强化物理治疗后改善停滞。必须排除其他病症，如关节不匹配、关节炎、痉挛、皮肤和皮下瘢痕形成以及游离体。我们根据病理解剖位置设计了一种分类系统，其中I型代表内在粘连，II型代表外在挛缩。这些类型根据病变所在位置进一步细分。对于存在关节内粘连的IA型（桡腕关节粘连）和IB型（腕中关节粘连），手术方法应为腕关节镜检查。IC型（桡尺远侧关节粘连）和II C型（桡尺远侧关节囊挛缩）最好采用开放方式，即对桡尺远侧关节进行背侧和掌侧关节囊切除术。对于IIA、B和D型（分别为背侧、掌侧和混合性外在挛缩），描述了开放和关节镜两种方法。
