Laulan J, Marteau E, Bacle G
Département de chirurgie orthopédique, CHRU de Tours, route de Loches, 37044 Tours cedex, France.
Département de chirurgie orthopédique, CHRU de Tours, route de Loches, 37044 Tours cedex, France.
Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S1-9. doi: 10.1016/j.otsr.2014.06.025. Epub 2015 Jan 14.
Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies.
疼痛性腕关节骨关节炎可导致严重的功能障碍。大多数病例与创伤后后遗症、代谢性关节病或炎性关节疾病有关，尽管腕关节骨关节炎在少数情况下为特发性疾病。仅在保守治疗失败时才考虑手术。主要目标是在恢复力量的同时确保缓解疼痛。通常首选保留运动的手术，尽管腕关节的残余活动度对良好功能并非至关重要。现有的大量手术技术包括切除性关节成形术、有限融合和全融合、全腕关节去神经术、部分和全关节成形术以及肋软骨移植植入术。手术决策取决于退行性腕关节病变的原因和程度、残余活动度、患者的意愿和功能需求。近端排腕骨切除术以及带舟骨切除的四角融合术是治疗舟月骨高级塌陷（SLAC）或舟骨不愈合高级塌陷（SNAC）腕关节所致II期腕关节骨关节炎最广泛使用的手术方法。III期疾病患者不适合行近端排腕骨切除术。全腕关节去神经术对于任何年龄、活动范围良好且功能需求较低的患者都是一种令人满意的治疗选择；此外，该手术的低发病率使其成为老年患者的良好选择，无论其活动范围如何。全腕关节融合术不仅可作为翻修手术，也可作为腕关节僵硬或广泛腕关节受累的重体力劳动者的主要手术治疗方法。鉴于现有研究随访时间较短，热解碳植入物、肋软骨移植植入术和全腕关节置换术的作用仍有待确定。
