Steiner Murphy M, Willsey Matthew R, Werner Frederick W, Harley Brian J, Klein Shay, Setter Kevin J
Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York.
J Wrist Surg. 2017 Feb;6(1):65-69. doi: 10.1055/s-0036-1587315. Epub 2016 Aug 5.
Proximal row carpectomy (PRC) is contraindicated in wrists with preexisting arthritis of the proximal capitate or radiolunate fossa. Patients with these conditions frequently pursue wrist arthrodesis with its associated functional limitations. The purpose of this study was to evaluate the results of using lateral meniscal allograft interposition (LMAI), in combination with PRC, in patients with symptomatic wrist arthritis. The primary question is whether this allograft will allow wrist function comparable to that in patients having only a PRC. A secondary question was to determine the short-term longevity of the allograft. Between 2006 and 2012, nine wrists underwent PRC with LMAI. Patient demographics and rates of complication or graft failure were determined. During independent clinical exams, functional outcomes were reviewed, patients completed a Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and radiographs were taken. Four patients met the inclusion criteria, having clinical follow-up at an average of 4.2 years. DASH scores at the time of follow-up ranged from 9 to 33, with an average of 24. Average radiocapitate joint space in the first postoperative radiograph was 2.8 mm compared with 1.8 mm at the time of final follow-up. No wrists went on to arthrodesis. Early outcomes of PRC with LMAI are comparable to those results found in the literature of PRC alone. LMAI with PRC may be a valid short-term option as a motion-preserving procedure in those patients contraindicated to having a PRC alone. Level IV.
对于已存在近端头状骨或桡月关节窝关节炎的腕关节，近端排腕骨切除术（PRC）是禁忌的。患有这些疾病的患者经常选择腕关节融合术，但这会带来相关的功能限制。本研究的目的是评估在有症状的腕关节关节炎患者中，使用外侧半月板同种异体移植置入术（LMAI）联合PRC的效果。主要问题是这种同种异体移植是否能使腕关节功能与仅接受PRC的患者相当。次要问题是确定同种异体移植的短期寿命。2006年至2012年期间，9例腕关节接受了PRC联合LMAI手术。确定了患者的人口统计学数据以及并发症或移植物失败率。在独立的临床检查中，评估了功能结果，患者完成了上肢、肩部和手部功能障碍（DASH）评分，并拍摄了X线片。4例患者符合纳入标准，平均临床随访4.2年。随访时的DASH评分在9至33之间，平均为24分。术后第一张X线片时的平均桡头关节间隙为2.8毫米，而最后随访时为1.8毫米。没有腕关节进行融合术。PRC联合LMAI的早期结果与文献中单独PRC的结果相当。对于单独进行PRC禁忌的患者，PRC联合LMAI作为一种保留运动的手术可能是一种有效的短期选择。四级。
