Mulders M A M, Sulkers G S I, Videler A J, Strackee S D, Smeulders M J C
Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Hand and Wrist Center Amsterdam, Amsterdam, The Netherlands.
J Wrist Surg. 2018 Jul;7(3):211-218. doi: 10.1055/s-0037-1612594. Epub 2017 Dec 21.
Patients with palmar midcarpal instability have symptoms of pain, combined with clinical signs of abnormal mobility on stressing the joint, an unpredictable blockade feeling, and a noticeable clunk, in the absence of an underlying trauma. No data are available on the effect of conservative treatment for these patients. The purpose of this study was to evaluate the effect and the long-term functional outcomes of a wrist exercise program in patients with palmar midcarpal instability. All patients diagnosed with palmar midcarpal instability between 2005 and 2011 were included. Patients completed the Patient-Rated Wrist and Hand Evaluation (PRWHE) and the Short Form-36 health (SF-36) questionnaires, scaled their perceived pain before and after treatment, and indicated the effect of the received treatment. A total of 119 patients diagnosed with palmar midcarpal instability were included. The median follow-up time was 6 years (IQR 4.5-7.0). The median PRWHE score after hand therapy was 35.5 and the median mental component of the SF-36 score was 53.9 and the physical component was 45.2. The median perceived pain reduced from eight to four and the median therapeutic effect of the wrist exercise program was five. Although palmar midcarpal instability remains to be a chronic disease, the effectiveness of our wrist exercise program is promising with acceptable long-term functional results and a good quality of life. Level IV, retrospective cohort study.
掌侧腕中关节不稳定的患者有疼痛症状，在对关节施加压力时伴有活动异常的临床体征、不可预测的卡顿感和明显的咯嗒声，且无潜在创伤史。目前尚无关于这些患者保守治疗效果的数据。 本研究的目的是评估腕部锻炼计划对掌侧腕中关节不稳定患者的疗效和长期功能结局。 纳入了2005年至2011年间所有诊断为掌侧腕中关节不稳定的患者。患者完成了患者自评腕部和手部评估（PRWHE）以及简短健康调查问卷（SF-36），对治疗前后的疼痛感受进行评分，并指出所接受治疗的效果。 总共纳入了119例诊断为掌侧腕中关节不稳定的患者。中位随访时间为6年（四分位间距4.5 - 7.0年）。手部治疗后的PRWHE评分中位数为35.5，SF-36评分的精神健康成分中位数为53.9，身体健康成分中位数为45.2。疼痛感受中位数从8降至4，腕部锻炼计划的治疗效果中位数为5。 尽管掌侧腕中关节不稳定仍是一种慢性疾病，但我们的腕部锻炼计划效果良好，具有可接受的长期功能结果和良好的生活质量。 四级，回顾性队列研究。
