Ewald Timothy J, Skeete Kshamata, Moran Steven L
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota.
J Wrist Surg. 2012 Aug;1(1):23-30. doi: 10.1055/s-0032-1324407.
This study reports the intermediate-term results of four patients from a series eight patients who have had an insertion of a new complete distal radioulnar joint (DRUJ) prosthesis. A retrospective review was performed for all patients who underwent DRUJ joint replacement with the STABILITY Sigmoid Notch Total DRUJ System between the years of 2003 and 2008. To be included in this report, all patients had to have more than 24 months of follow-up and hand examination by the senior author. From the eight patients with this procedure, four patients met the inclusion criteria. These included one patient with painful posttraumatic arthritis, two patients with failed hemiarthroplasty, and one patient with a failed Sauvé-Kapandji procedure. Mean age at the time of surgery was 42.5 years (range: 35 to 51 years) and mean follow-up was 46 months (range: 36 to 66 months). Preoperative and postoperative assessment included range of motion, grip strength, visual analog pain scale, patient satisfaction, and radiographic evaluation. There was a successful replacement of the DRUJ in all four patients. Final range of motion showed mean pronation of 80 degrees (range: 60 to 90 degrees) and mean supination of 64 degrees (range: 45 to 90 degrees). Final grip strength on the operated extremity was 25.5 kg and averaged 73% of contralateral side. This was an improvement from preoperative grip strength of 14.5 kg visual analog pain scale decreased from 8 to 2.5 following surgery (scale: 1 to 10). Patient satisfaction was 100%. One patient returned to manual labor, one patient returned to office work, and two patients remained off work. Postoperative radiographs depict appropriate alignment of the DRUJ, and there have been no cases of subluxation or dislocation. Implant survival has been 100%. Total DRUJ joint replacement with sigmoid notch resurfacing and distal ulna replacement is an alternative to ulnar head resection in cases of DRUJ arthritis. Total DRUJ arthroplasty with this resurfacing design may provide a means of decreasing pain and restoring DRUJ stability and motion following severe trauma, failed hemiarthroplasty, or failed Sauvé-Kapandji procedure. More experience is needed with this implant to confirm these initial encouraging results. The level of evidence for this study is IV (therapeutic, case series).
本研究报告了8例植入新型完整桡尺远侧关节（DRUJ）假体患者中的4例患者的中期结果。对2003年至2008年间接受使用STABILITY Sigmoid Notch全DRUJ系统进行DRUJ关节置换的所有患者进行了回顾性研究。要纳入本报告，所有患者必须有超过24个月的随访且由资深作者进行手部检查。在接受该手术的8例患者中，4例患者符合纳入标准。其中包括1例创伤后疼痛性关节炎患者、2例半关节成形术失败患者和1例Sauvé-Kapandji手术失败患者。手术时的平均年龄为42.5岁（范围：35至51岁），平均随访时间为46个月（范围：36至66个月）。术前和术后评估包括活动范围、握力、视觉模拟疼痛量表、患者满意度和影像学评估。所有4例患者的DRUJ置换均成功。最终活动范围显示平均旋前80度（范围：60至90度），平均旋后64度（范围：45至90度）。患侧最终握力为25.5千克，平均为对侧的73%。这较术前握力14.5千克有所改善，术后视觉模拟疼痛量表评分从8降至2.5（量表范围：1至10）。患者满意度为100%。1例患者恢复体力劳动，1例患者恢复办公室工作，2例患者仍未工作。术后X线片显示DRUJ对线良好，无半脱位或脱位病例。植入物生存率为100%。对于DRUJ关节炎病例，采用乙状切迹表面置换和尺骨远端置换的全DRUJ关节置换是尺骨头切除的一种替代方法。采用这种表面置换设计的全DRUJ关节成形术可能为严重创伤、半关节成形术失败或Sauvé-Kapandji手术失败后减轻疼痛、恢复DRUJ稳定性和活动提供一种方法。需要更多关于该植入物的经验来证实这些初步令人鼓舞的结果。本研究的证据水平为IV级（治疗性，病例系列）。
