Vanhove W, De Vil J, Van Seymortier P, Boone B, Verdonk R
Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
J Hand Surg Eur Vol. 2008 Apr;33(2):118-25. doi: 10.1177/1753193408087116.
Four-corner arthrodesis and proximal row carpectomy are motion-preserving salvage solutions for the scapholunate advanced collapse wrist. We compared both procedures in a non-randomised, retrospective study of 30 cases with a mean follow-up of 3(1/2) years. Pain relief and functional gain were equal in both treatment groups. However, the complication rate was higher in the four-corner arthrodesis group, partly because of the need for internal fixation. The higher incidence of carpal tunnel syndrome following four-corner arthrodesis is intriguing. We also found significant differences in the duration of hospital stay and of postoperative sick leave in favour of proximal row carpectomy. If the cartilage on the capitate head is well preserved (Stages I-II), we prefer proximal row carpectomy because of the socio-economic benefits, the lower complication rate and the ease of the procedure. Degenerative changes following proximal row carpectomy may be a concern in young manual labourers, but have not been observed.
四角融合术和近排腕骨切除术是针对舟月骨高级塌陷型腕关节的保留运动功能的挽救性手术。我们在一项非随机回顾性研究中比较了这两种手术，该研究纳入了30例患者，平均随访时间为3.5年。两个治疗组在疼痛缓解和功能改善方面相当。然而，四角融合术组的并发症发生率更高，部分原因是需要内固定。四角融合术后腕管综合征的较高发生率很有意思。我们还发现，住院时间和术后病假时长存在显著差异，近排腕骨切除术更具优势。如果头状骨头部的软骨保存良好（I-II期），考虑到社会经济效益、较低的并发症发生率和手术的简便性，我们更倾向于选择近排腕骨切除术。近排腕骨切除术后的退变改变可能是年轻体力劳动者关注的问题，但尚未观察到此类情况。
