Boeckstyns Michel E H
Håndkirurgisk Afdeling Z, Gentofte Hospital, Niels Andersens Vej 65, 2900 Gentofte, Denmark.
Dan Med J. 2014 May;61(5):A4834.
Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study was to review the literature on second, third and fourth generation implants.
The review was conducted according to the PRISMA-guidelines. A search was made using a protocolled strategy and well-defined criteria in PubMed, in the Cochrane Library and by screening reference lists.
37 publications describing a total of 18 implants were selected for analysis. 16 of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible.
It seems that T/PWA has a good potential to improve function through pain reduction and preservation of mobility. The risk of severe complications - deep infection and instability problems - is small with the available implants. Implant survival of 90-100% at five years are reported in most series - if not all - using newer second generation and third generation implants, but declines from five to eight years. Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified.
严重疼痛或功能失调的毁损性腕关节可通过融合、软组织植入或使用人工材料的关节成形术进行重建。自20世纪60年代以来，全腕关节置换术和半腕关节置换术（T/PWA）已被常规使用。本研究的目的是回顾关于第二代、第三代和第四代植入物的文献。
根据PRISMA指南进行综述。采用拟定的策略和明确的标准在PubMed、Cochrane图书馆进行检索，并筛选参考文献列表。
选择了37篇描述总共18种植入物的出版物进行分析。其中16篇出版物对评估植入物的使用寿命有用。尽管许多原始文献存在方法学缺陷，但仍有可能进行汇总估计。
T/PWA似乎有很大潜力通过减轻疼痛和保留活动度来改善功能。使用现有植入物时，严重并发症——深部感染和不稳定问题——的风险较小。大多数系列报道（如果不是全部的话），使用更新的第二代和第三代植入物时，五年时植入物生存率为90%-100%，但从五年到八年有所下降。假体周围骨溶解/透亮区经常被报道。其原因和后果尚不清楚。
