Service de Chirurgie Orthopédique, CHU de Brest, Hôpital de la Cavale-Blanche, 29200 Brest, France.
Orthop Traumatol Surg Res. 2011 Jun;97(4 Suppl):S31-6. doi: 10.1016/j.otsr.2011.03.006. Epub 2011 Apr 29.
The primary goal in treating a degenerative wrist is to provide pain relief, while maintaining strength and mobility if possible. After failure of the recommended conservative treatment, the choice of approaches can be made from a large collection of techniques, some which are well validated. Partial wrist fusion, particularly the Watson procedure, results in a pain-free wrist in 80% of cases, with 50% of the mobility preserved, good grasping strength and stable results for at least 10 years. Proximal row carpectomy provides similar results if the cartilage on the head of the capitate is preserved and the patient is not involved in heavy manual labour. Complete denervation provides pain relief in almost 80% of cases while preserving motion and strength. This is a safe and effective option, with no age limit, that still allows other procedures to be performed in the future. Total wrist fusion also has its place in revision, and even as first-line treatment, because of the reliable outcome in terms of pain and strength, high satisfaction rates, little to no repercussions linked to the loss of mobility and fewer complications. Other techniques are now available. The partial or complete resection of a carpal bone and placement of an implant is back in vogue because of the availability of pyrocarbon. Such implants are an option in the future for localized osteoarthritis or even diffuse affections, and a useful alternative to more invasive procedures. The use of a rib cartilage graft to partially or completely replace a carpal bone or resurface the radius has promising results in terms of pain reduction and fusion. The role of total joint replacement must be defined relative to the classic, reliable techniques that have long-term outcome data.
IV.
治疗退行性腕关节的主要目标是缓解疼痛，同时尽可能保持力量和活动度。在推荐的保守治疗失败后，可以从大量技术中选择治疗方法，其中一些技术已经得到很好的验证。部分腕关节融合术，特别是 Watson 手术，可使 80%的病例腕关节无痛，保留 50%的活动度，握力良好，结果稳定至少 10 年。如果头状骨软骨保留且患者不从事重体力劳动，近端桡腕关节切除术可提供类似的结果。完全去神经支配可在保留运动和力量的情况下缓解近 80%的疼痛。这是一种安全有效的选择，没有年龄限制，将来仍可进行其他手术。全腕关节融合术在翻修中也有其位置，甚至作为一线治疗方法，因为在疼痛和力量方面有可靠的结果、高满意度、与丧失活动度相关的几乎没有任何影响、以及较少的并发症。现在有其他技术可供选择。由于存在热解碳，部分或全部切除腕骨并植入植入物又重新流行起来。此类植入物是未来治疗局限性骨关节炎甚至弥漫性疾病的一种选择，是更具侵袭性手术的有用替代方法。使用肋软骨移植物部分或完全替代腕骨或覆盖桡骨具有减轻疼痛和融合的良好结果。全关节置换的作用必须相对于具有长期结果数据的经典可靠技术来定义。
IV。
