Noback Peter C, Seetharaman Mani, Danoff Jonathan R, Birman Michael, Rosenwasser Melvin P
1 Columbia University Medical Center, New York, USA.
Hand (N Y). 2018 Nov;13(6):659-665. doi: 10.1177/1558944717725383. Epub 2017 Aug 20.
Symptomatic stage 2 or 3 scapholunate advanced collapse (SLAC) wrist is aggressively treated with salvage procedures, such as proximal row carpectomy or partial wrist fusion with resultant pain relief but limited motion. We hypothesize that arthroscopic synovectomy, radial styloidectomy, and neurectomy will preserve wrist motion, relieve pain, and delay or avoid salvage procedures.
We evaluated outcomes in 13 wrists through questionnaires and 11 of these through additional physical examination at a mean follow-up of 5.0 years. Eight wrists were stage 2 and 5 were stage 3. Data at final follow-up included mobility/strength measurements, subjective outcome scores (Disabilities of the Arm, Shoulder, and Hand [DASH] and visual analog scale [VAS] pain), patient satisfaction, and return to work statistics.
Patients had an average flexion-extension arc of 88.0° in the treated wrist and an average grip strength that was 95.0% of the contralateral side. No patients required revision surgery at follow-up. The 13 wrists reported an average DASH score of 16.4 and mean VAS pain score at rest and with activity of 17.9 and 31.6, respectively. All patients working prior to the procedure (n = 8) were able to immediately return to work. In all, 84.6% of patients were satisfied.
The procedure studied may have advantages in relieving pain, while preserving wrist motion for SLAC stage 2 or 3 disease. This procedure does not preclude future salvage procedures in those patients with severe disease who prefer to maintain wrist motion for the short term. Patients experience good functional outcomes with the majority experiencing a reduction in pain with the ability to return to work.
有症状的2期或3期舟月骨高级塌陷（SLAC）腕关节采用挽救性手术积极治疗，如近排腕骨切除术或部分腕关节融合术，术后疼痛缓解但活动受限。我们假设关节镜下滑膜切除术、桡骨茎突切除术和神经切除术将保留腕关节活动度、缓解疼痛并延迟或避免挽救性手术。
我们通过问卷调查评估了13例腕关节的结果，并对其中11例进行了额外的体格检查，平均随访5.0年。8例腕关节为2期，5例为3期。末次随访数据包括活动度/力量测量、主观结果评分（手臂、肩部和手部功能障碍[DASH]和视觉模拟量表[VAS]疼痛）、患者满意度和重返工作统计数据。
治疗后的腕关节平均屈伸弧度为88.0°，平均握力为对侧的95.0%。随访期间无患者需要翻修手术。13例腕关节的平均DASH评分为16.4，静息和活动时的平均VAS疼痛评分分别为17.9和31.6。所有术前工作的患者（n = 8）均能够立即重返工作岗位。总体而言，84.6%的患者表示满意。
所研究的手术在缓解疼痛方面可能具有优势，同时保留SLAC 2期或3期疾病的腕关节活动度。对于那些希望短期内保持腕关节活动度的重症患者，该手术并不排除未来进行挽救性手术的可能性。患者功能结局良好，大多数患者疼痛减轻且能够重返工作岗位。
