Nydick Jason A, Greenberg Scott M, Stone Jeffrey D, Williams Bailee, Polikandriotis John A, Hess Alfred V
Florida Orthopaedic Institute, Tampa, FL, USA.
J Hand Surg Am. 2012 Aug;37(8):1580-4. doi: 10.1016/j.jhsa.2012.05.016. Epub 2012 Jul 3.
Current indications for total wrist arthroplasty include patients with symptomatic end stage posttraumatic wrist arthritis, rheumatoid arthritis, and Kienböck disease, as an alternative to wrist arthrodesis. Arthroplasty may have advantage over arthrodesis because of the ability to retain motion. The purpose of this study was to evaluate the short-term clinical outcomes and complications of the Maestro Total Wrist System.
We report the results of a retrospective review of 23 total wrist prostheses implanted in 22 patients. We administered the visual analog pain scale and Mayo wrist and Disabilities of the Arm, Shoulder, and Hand questionnaires. We reviewed wrist motion, grip strength, radiographs, and complications.
At a mean follow-up of 28 months (range, 4-55 mo), the Disabilities of the Arm, Shoulder, and Hand score and Mayo wrist score were 31 and 54, respectively. Mean pain scores improved from 8.0 to 2.2. The mean wrist flexion-extension arc was 90°. Radiographs revealed no evidence of prosthetic loosening. Grip strength averaged 60% of the strength of the opposite hand. Complications occurred in 7 of 23 patients. One failure occurred as a result of deep infection in a patient with prior intercarpal fusion, and was successfully converted to a wrist fusion.
Total wrist arthroplasty performed for pancarpal arthritis as an alternative to wrist arthrodesis can yield successful outcomes with low short-term failure rates.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
全腕关节置换术目前的适应证包括有症状的创伤后终末期腕关节炎、类风湿关节炎和月骨无菌性坏死患者，作为腕关节融合术的替代方法。由于保留活动能力，关节置换术可能优于关节融合术。本研究的目的是评估Maestro全腕系统的短期临床疗效和并发症。
我们报告了对22例患者植入的23个全腕假体进行回顾性研究的结果。我们采用了视觉模拟疼痛量表以及梅奥腕关节和上肢、肩部和手部功能障碍问卷。我们评估了腕关节活动度、握力、X线片以及并发症情况。
平均随访28个月（范围4 - 55个月），上肢、肩部和手部功能障碍评分及梅奥腕关节评分分别为31分和54分。平均疼痛评分从8.0分改善至2.2分。平均腕关节屈伸弧度为90°。X线片显示无假体松动迹象。患侧握力平均为对侧手的60%。23例患者中有7例出现并发症。1例曾行腕骨间融合术的患者因深部感染导致手术失败，最终成功转换为腕关节融合术。
对于全腕关节炎患者，全腕关节置换术作为腕关节融合术的替代方法，可取得成功的疗效，短期失败率较低。
研究类型/证据水平：治疗性IV级。
