Berkhout Merel J L, Bachour Yara, Zheng Kang He, Mullender Margriet G, Strackee Simon D, Ritt Marco J P F
Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
J Hand Surg Am. 2015 Jul;40(7):1349-54. doi: 10.1016/j.jhsa.2014.12.035. Epub 2015 Feb 18.
To compare the long-term outcomes of proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) in a consecutive series of patients surgically treated between 1989 and 1998 in a single teaching hospital.
We included 12 patients (14 wrists) in the PRC group and 8 patients (8 wrists) in the FCA group. Mean follow-up time was 17 years. We compared functional outcome measures (range of motion and grip strength) and patient-reported outcome measures (visual analog score for pain, Mayo Wrist Score, and Michigan Hand Questionnaire). Radiographic evaluation of joint degeneration using the Culp and Jebson scoring system and postoperative complications were assessed for both groups.
Active range of motion was slightly better after PRC. There were no differences in grip strength and patient-reported outcomes between groups. Severity of degenerative changes did not differ between groups and was not correlated with pain scores. The FCA group showed more postoperative complications.
Considering the objective and patient-reported outcomes of this study, both types of surgery perform well in the long run. Proximal row carpectomy seems to result in slightly better movement of the wrist with fewer surgical complications and no need for hardware removal. Moreover, postoperative immobilization time was much shorter.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
比较1989年至1998年在一家教学医院接受手术治疗的连续系列患者中，近排腕骨切除术（PRC）和四角融合术（FCA）的长期疗效。
我们纳入了12例患者（14只腕关节）的PRC组和8例患者（8只腕关节）的FCA组。平均随访时间为17年。我们比较了功能结局指标（活动范围和握力）以及患者报告的结局指标（疼痛视觉模拟评分、梅奥腕关节评分和密歇根手问卷）。使用卡尔普（Culp）和杰布森（Jebson）评分系统对两组的关节退变进行影像学评估，并评估术后并发症。
PRC术后主动活动范围略好。两组之间握力和患者报告的结局无差异。两组之间退变改变的严重程度无差异，且与疼痛评分无关。FCA组术后并发症更多。
考虑到本研究的客观和患者报告的结局，从长远来看，两种手术方式效果均良好。近排腕骨切除术似乎能使腕关节活动略好，手术并发症更少，且无需取出内固定物。此外，术后固定时间短得多。
研究类型/证据水平：治疗性III级。
