Department of Upper Extremity, Hand and Microsurgery, Immanuel Hospital, Königstrasse 63, 14109, Berlin, Germany.
Int Orthop. 2013 Dec;37(12):2409-13. doi: 10.1007/s00264-013-2063-6. Epub 2013 Aug 18.
The wrist is involved early in rheumatoid arthritis and is often severely affected. A stable wrist is crucial to good hand function, which often necessitates a fusion. One of the most commonly used techniques in rheumatoid patients is the Mannerfelt arthrodesis. In this retrospective study the outcome and the patient's subjective satisfaction are presented and compared to other techniques. Also the influence of the position of the wrist following a fusion procedure is analysed.
Thirty-four wrists were retrospectively analysed using radiological measurements, functional scores such as the Disabilities of the Arm, Shoulder and Hand (DASH) and a pain assessment. The objective function of the hand with the fused wrist was assessed.
In 92.6% of wrists the patients rated their satisfaction as good or excellent. The mean DASH score post-operatively was 63.3. Of the wrists, 17 were fixed in a median flexed position of 13° and 17 wrists in a median extended position of 8°. There was no statistically significant correlation between the position of the wrist and the satisfaction or objective function. The rate of fusion was 94.1%.
The Mannerfelt arthrodesis achieves good results and provides a high rate of satisfaction and pain relief in our study. It has major advantages compared to other wrist fusion techniques in the rheumatoid patient. We could not show clear statistical evidence for better results in either a flexed or an extended position, but the ratings of the patients indicated better subjective results with a slightly extended position of the arthrodesis.
手腕在类风湿关节炎中早期受累，且常严重受影响。稳定的手腕对于良好的手部功能至关重要，而手部功能往往需要融合。类风湿患者中最常用的技术之一是曼内费尔特融合术。在这项回顾性研究中，我们展示并比较了该技术的结果和患者的主观满意度，并分析了融合术后手腕位置的影响。
我们回顾性分析了 34 例腕关节，使用影像学测量、功能评分（如手臂、肩部和手残疾量表（DASH））和疼痛评估来评估腕关节。评估融合后手部的客观功能。
92.6%的患者对手术效果满意度评价为良好或优秀。术后 DASH 平均得分为 63.3。其中，17 例手腕固定在中位弯曲位置 13°，17 例固定在中位伸展位置 8°。手腕位置与满意度或客观功能之间无统计学显著相关性。融合率为 94.1%。
在我们的研究中，曼内费尔特融合术取得了良好的效果，提供了较高的满意度和缓解疼痛的效果。与类风湿患者的其他腕关节融合技术相比，它具有显著优势。我们无法提供明确的统计学证据表明在弯曲或伸展位置下会有更好的结果，但患者的评分表明，融合术稍伸展的位置会有更好的主观效果。
