Allieu Y, Lussiez B, Asencio G
Service de Chirurgie Orthopédique et Chirurgie de la Main (CHU Montpellier), Hôpital Lapeyronie.
Rev Chir Orthop Reparatrice Appar Mot. 1989;75(3):172-8.
Sixty rheumatoid wrists operated on for tendon articular synovectomies and resection of the ulnar head have been reviewed with an average follow-up of 5 years and 4 months. One-third of these patients who presented an average follow-up of 8 years and 8 months have been isolated for the radio-clinical analysis. The results on pain are good (78 per cent of patients are painless at 5 years and 67 per cent at 8 years); 80 per cent present no recurrence of tenosynovitis, and 75 per cent show a functional improvement. The study of mobility sectors shows a loss of 28 per cent on the sagittal plane and 21 per cent on the frontal plane at 5 years, which increases respectively at 33 per cent and 41 per cent at 8 years, with however a sector of useful mobility preserved. The prehension strength decreases but the parameter must take into account the polyarticular evolution of the disease. If long-term results are clinically satisfactory, isolated synovectomy does not prevent radiological aggravation which is due to the evolution of the disease. This is the reason why, prevently, intracarpal arthrodeses or tendon transfers must also be performed, when there are signs of instability or partial wrist destructions.
对60例因肌腱关节滑膜切除术和尺骨头切除术而接受手术的类风湿性手腕进行了回顾性研究，平均随访时间为5年4个月。其中三分之一平均随访8年8个月的患者被单独挑选出来进行放射学和临床分析。疼痛方面的结果良好（5年时78%的患者无痛，8年时为67%）；80%的患者腱鞘炎无复发，75%的患者功能得到改善。对活动度的研究显示，5年时矢状面活动度丧失28%，额状面丧失21%，8年时分别增加到33%和41%，不过仍保留了一部分有用的活动度。抓握力下降，但该参数必须考虑到疾病的多关节进展情况。如果长期结果在临床上令人满意，单纯滑膜切除术并不能阻止由于疾病进展导致的放射学恶化。这就是为什么在出现不稳定迹象或腕部部分破坏时，预防性地还必须进行腕骨融合术或肌腱转移术。
