Weiss Noah D, Molina Ricardo A, Gwin Stephanie
San Francisco Orthopaedic Residency Program, St Mary's Medical Center, San Francisco, CA, USA.
J Hand Surg Am. 2011 Apr;36(4):577-82. doi: 10.1016/j.jhsa.2011.01.009.
Proximal row carpectomy is an effective procedure for treating a variety of wrist pathologies. To date, all outcome studies have reported on the results of an open procedure, with a dorsal capsulotomy. We present our technique and early results of arthroscopic proximal row carpectomy.
A total of 17 consecutive patients (10 men and 7 women) underwent arthroscopic proximal row carpectomy. After routine arthroscopy, the proximal carpal row was removed with an arthroscopic bur, with care being taken to protect the articular cartilage of the head of the capitate and the lunate fossa. The average time of the procedure was 70 minutes (range, 34-110 min). Range of motion exercise was initiated 2 days postoperatively. We assessed clinical follow-up objectively by evaluating range of motion and grip strength. We assessed subjective outcomes with the Disabilities of the Arm, Shoulder, and Hand questionnaire and with a patient-centered questionnaire assessing satisfaction, return to prior employment, and pain.
A total of 16 patients were available, with an average follow-up of 24 months (range, 12-48 mo). There were no complications, no revisions were required, and no arthroscopic procedure was converted to open technique. At final follow-up, the average wrist flexion-extension arc was 80% of the contralateral side, and grip strength averaged 81% of the contralateral side. The mean Disabilities of the Arm, Shoulder, and Hand score was 21. All 16 patients rated themselves as satisfied or very satisfied with the procedure. Eleven patients had no work restrictions and 13 were able to return to previous employment. Ten patients rated themselves as having mild or no pain.
Arthroscopic proximal row carpectomy appears to be a safe, effective, and reliable procedure for a variety of wrist conditions, and it allows for rapid mobilization of the wrist compared with the open procedure. Range of motion and grip strength compare favorably with existing values in the literature for the open technique.
近排腕骨切除术是治疗多种腕部疾病的有效方法。迄今为止，所有疗效研究均报道了切开手术（伴有背侧关节囊切开术）的结果。我们介绍关节镜下近排腕骨切除术的技术及早期结果。
连续17例患者（10例男性，7例女性）接受了关节镜下近排腕骨切除术。常规关节镜检查后，用关节镜磨钻切除近侧腕骨排，注意保护头状骨头和月骨窝的关节软骨。手术平均时间为70分钟（范围34 - 110分钟）。术后2天开始进行活动度锻炼。我们通过评估活动度和握力客观地评估临床随访情况。我们用手臂、肩部和手部功能障碍问卷以及一份以患者为中心的评估满意度、恢复原工作情况和疼痛的问卷来评估主观结果。
共有16例患者可供随访，平均随访24个月（范围12 - 48个月）。无并发症发生，无需翻修，也没有将关节镜手术转为切开手术。末次随访时，患侧腕关节屈伸弧度平均为对侧的80%，握力平均为对侧的81%。手臂、肩部和手部功能障碍平均评分为21分。16例患者均对手术表示满意或非常满意。11例患者没有工作限制，13例能够恢复原工作。10例患者表示疼痛轻微或无疼痛。
关节镜下近排腕骨切除术对于多种腕部疾病似乎是一种安全、有效且可靠的手术方法，与切开手术相比，它能使腕关节更快地活动。活动度和握力与文献中切开手术的现有数值相比具有优势。
