Giacalone Francesco, di Summa Pietro G, Fenoglio Alessandro, Sard Arman, Dutto Elisa, Ferrero Matteo, Bertolini Maddalena, Garcia-Elias Marc
Turin, Italy; Lausanne, Switzerland; and Barcelona, Spain.
From the Department of Hand Surgery, CTO-Maria Adelaide Trauma and Orthopaedic Hospital; the Department of Plastic, Reconstructive, and Hand Surgery, Centre Hospitalier Universitaire Vaudois; and the Institut Kaplan.
Plast Reconstr Surg. 2017 Nov;140(5):962-970. doi: 10.1097/PRS.0000000000003759.
The Resurfacing Capitate Pyrocarbon Implant associated with proximal row carpectomy has been used to treat symptomatic advanced carpal collapse, widening the indications of proximal row carpectomy to patients with capitate head arthritis. The authors retrospectively compared their case series of implant versus carpectomy alone, analyzing whether prosthetic implant outcomes could be similar to those of proximal row carpectomy even with a higher stage of osteoarthritis.
Fifty-seven patients who underwent surgery for wrist osteoarthritis (minimum follow-up, 2 years) were selected retrospectively. Twenty-five patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage III to IV and Kienböck disease stage IV) underwent proximal row carpectomy plus Resurfacing Capitate Pyrocarbon Implant (group A); 32 patients (scapholunate advanced collapse/scaphoid nonunion advanced collapse stage I to II and Kienböck disease stage III) underwent carpectomy alone (group B). Mean follow-up was 33 months. Patients were evaluated clinically and radiographically. Patient-Rated Wrist Evaluation and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were assessed.
Group A showed consistent pain relief (visual analogue scale score of 2), while preserving wrist mobility (flexion, 27 degrees; extension, 33 degrees) and grip strength (54 percent compared with the contralateral side). Average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 20, and average Patient-Rated Wrist Evaluation score was 28. No statistically significant difference was observed between groups for all outcomes, except for better extension (p < 0.05) in group B.
Even starting from a higher grade of osteoarthritis, Resurfacing Capitate Pyrocarbon Implant plus proximal row carpectomy showed satisfying results, compared with those obtained with just carpectomy. Data show that indications for proximal row carpectomy can be widened by using the implant, without worsening outcomes. The implant could be a useful alternative to more aggressive salvage procedures in case of capitate head and lunate fossa osteoarthritis involvement.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
与近排腕骨切除术联合使用的头状骨表面重建热解碳植入物已被用于治疗有症状的晚期腕骨塌陷，将近排腕骨切除术的适应证扩展到患有头状骨头关节炎的患者。作者回顾性比较了他们植入物病例系列与单纯腕骨切除术的病例系列，分析即使在骨关节炎更严重阶段，假体植入的结果是否能与近排腕骨切除术的结果相似。
回顾性选择57例行腕关节骨关节炎手术（最短随访2年）的患者。25例患者（舟月骨高级塌陷/舟骨不愈合高级塌陷Ⅲ至Ⅳ期和月骨无菌性坏死Ⅳ期）接受近排腕骨切除术加头状骨表面重建热解碳植入物（A组）；32例患者（舟月骨高级塌陷/舟骨不愈合高级塌陷Ⅰ至Ⅱ期和月骨无菌性坏死Ⅲ期）仅接受腕骨切除术（B组）。平均随访33个月。对患者进行临床和影像学评估。评估患者腕关节评分和上肢、肩部和手部功能障碍问卷评分。
A组疼痛持续缓解（视觉模拟量表评分为2），同时保留腕关节活动度（屈曲27度；伸展33度）和握力（与对侧相比为54%）。上肢、肩部和手部功能障碍问卷平均评分为20分，患者腕关节评分平均为28分。除B组伸展功能更好（p<0.05）外，两组所有结果均未观察到统计学显著差异。
即使从更严重的骨关节炎级别开始，与单纯腕骨切除术相比，头状骨表面重建热解碳植入物加近排腕骨切除术也显示出令人满意的结果。数据表明，使用植入物可扩大近排腕骨切除术的适应证，且不会使结果恶化。在头状骨头和月骨窝骨关节炎受累的情况下，该植入物可能是更积极的挽救手术的有用替代方案。
临床问题/证据水平：治疗性，Ⅲ级。
