Baur Eva-Maria
Practice for Plastic and Hand Surgery, James-Loeb-Str. 13, Murnau D-82418, Germany.
Hand Clin. 2017 Nov;33(4):735-753. doi: 10.1016/j.hcl.2017.07.013.
Partial wrist arthrodesis (PWA) is a well-known procedure for treating degenerative or posttraumatic wrist conditions. Four-corner fusion (4CF) is mostly used for scapholunate advanced collapse and scaphoid nonunion advanced collapse. The author performed 39 procedures, including 4CFs, 2-corner fusions, 3-corner fusions, scaphoid-capitate/scaphoid-capitate-lunate fusions, scaphoid-trapezium-trapezoid arthrodeses, and radioscapholunate arthroscopic PWAs (A-PWAs). There were 8 revision cases including 4 partial nonunions. All A-PWAs healed satisfactorily after revision surgery. This article discusses the surgical techniques and tips to avoid mistakes. The pros and cons for open versus arthroscopic techniques and for screws versus Kirschner wires are also discussed.
部分腕关节融合术(PWA)是治疗退行性或创伤后腕部疾病的一种知名手术。四角融合术(4CF)主要用于舟月骨晚期塌陷和舟骨不愈合晚期塌陷。作者实施了39例手术,包括4CF、两角融合术、三角融合术、舟骨-头状骨/舟骨-头状骨-月骨融合术、舟骨-大多角骨-小多角骨关节融合术以及桡舟月关节镜下PWA(A-PWA)。有8例翻修病例,其中包括4例部分不愈合。所有A-PWA在翻修手术后均愈合良好。本文讨论了手术技术及避免失误的技巧。还讨论了开放手术与关节镜技术以及螺钉与克氏针的优缺点。