DeGeorge Brent R, Berger Richard A, Shin Alexander Y
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2019 Jul;44(7):614.e1-614.e9. doi: 10.1016/j.jhsa.2018.09.003. Epub 2018 Oct 18.
Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty.
We performed a retrospective review of patients undergoing semiconstrained DRUJ implant arthroplasty with clinical and radiological follow-up greater than 1 year. Data were reviewed with a focus on soft tissue complications after arthroplasty.
Fifty DRUJ implant arthroplasties were performed over 10 years in 49 patients. Patients' average age was 47.8 years. Average duration of follow-up was 35.8 ± 3.7 months. A total of 46 patients underwent multiple operations before DRUJ arthroplasty. Postoperative pronosupination range of motion, grip strength, and visual analog scale pain scores were significantly improved after DRUJ arthroplasty. Wound-healing problems occurred in 11 arthroplasties; however, all wounds subsequently healed without operative intervention. Wound-related complications were significantly increased in patients with a history of rheumatoid arthritis or immunosuppression. Eighteen operations were required to address complications in 8 patients. Extensor tendinopathy was the most common indication for reoperation; 5 tenosynovectomy procedures were required in 4 wrists. A prominent screw requiring removal was identified in 3 cases of tenosynovitis. Periprosthetic fractures were identified in 3 wrists; 2 of these required reoperation for open treatment. Removal of hardware was required in 2 patients; these patients required 9 subsequent reoperations.
Distal radioulnar joint arthrosis is a major problem and patients commonly undergo multiple reconstructive surgeries before DRUJ implant arthroplasty. No instances of wound-related complications or tendinopathy occurred in patients without previous surgeries, and wound-related complications occurred at a higher frequency with a history of rheumatoid arthritis or immunosuppression.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
作为旨在替代尺骨头、桡骨乙状切迹和三角纤维软骨复合体功能的半限制性装置，远侧桡尺关节（DRUJ）假体已显示出恢复DRUJ功能状态的能力。然而，包括肌腱、神经和伤口在内的软组织并发症虽有记录，但并非既往报告的主要关注点。本研究调查了DRUJ半限制性植入关节成形术后的短期至中期软组织并发症。
我们对接受DRUJ半限制性植入关节成形术且临床和影像学随访超过1年的患者进行了回顾性研究。重点回顾了关节成形术后的软组织并发症数据。
在10年期间，对49例患者进行了50次DRUJ植入关节成形术。患者平均年龄为47.8岁。平均随访时间为35.8±3.7个月。共有46例患者在DRUJ关节成形术前接受了多次手术。DRUJ关节成形术后，旋前旋后活动范围、握力和视觉模拟量表疼痛评分均有显著改善。11例关节成形术出现伤口愈合问题；然而，所有伤口随后均未进行手术干预而愈合。有类风湿关节炎或免疫抑制病史的患者伤口相关并发症显著增加。8例患者需要进行18次手术来处理并发症。伸肌腱病是再次手术最常见的原因；4例手腕需要进行5次腱鞘切除术。在3例腱鞘炎病例中发现有突出的螺钉需要取出。3例手腕发现假体周围骨折；其中2例需要再次手术进行切开治疗。2例患者需要取出内固定物；这些患者随后需要进行9次再次手术。
远侧桡尺关节关节炎是一个主要问题，患者在DRUJ植入关节成形术前通常会接受多次重建手术。既往未接受过手术的患者未出现伤口相关并发症或肌腱病，而有类风湿关节炎或免疫抑制病史的患者伤口相关并发症发生率更高。
研究类型/证据水平：预后性IV级。
