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达拉赫与绍韦-卡潘迪手术治疗创伤后远侧桡尺关节功能障碍的对比研究。

A Comparative Study Between Darrach and Sauvé-Kapandji Procedures for Post-Traumatic Distal Radioulnar Joint Dysfunction.

机构信息

Massachusetts General Hospital, Harvard Medical School, Boston, USA.

VU University Medical Center, Amsterdam, The Netherlands.

出版信息

Hand (N Y). 2021 May;16(3):375-384. doi: 10.1177/1558944719855447. Epub 2019 Jun 27.

Abstract

There are various treatments for post-traumatic distal radioulnar joint (DRUJ) dysfunction. The present study aimed to assess differences in long-term patient-reported outcomes on physical function, pain, and satisfaction between the Darrach and Sauvé-Kapandji procedures. Secondary aims were to describe the radiographic outcomes and to assess the difference in rate and type of complications and reoperations between these 2 procedures. We retrospectively analyzed 85 patients who had a post-traumatic DRUJ derangement and had been treated by either a Darrach (n = 57) or Sauvé-Kapandji procedure (n = 28). Fifty-two patients (61%) completed patient-rated outcomes surveys at a median of 8.4 years after their procedure. Radiographic measurements consisted of ulnar distance, radioulnar distance, and ulnar gap (only in Sauvé-Kapandji group). There were no significant differences in Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Function score, pain score, satisfaction score, complications, and reoperations between patients who had a Darrach procedure or a Sauvé-Kapandji procedure. Seventeen patients (30%) in the Darrach group experienced a complication, and 14 patients (50%) in the Sauvé-Kapandji group experienced a complication ( = .09). The most common complication was instability of the ulnar stump (n = 10), followed by symptoms of the dorsal sensory branch of the ulnar nerve (n = 8). Patients who underwent a Sauvé-Kapandji procedure had more reoperations for excision of heterotopic ossification. Darrach and Sauvé-Kapandji procedures show comparable long-term patient-reported outcomes in treatment of post-traumatic DRUJ dysfunction. Complication and reoperation rate are relatively high, with non-significant differences between the 2 procedures.

摘要

创伤后下尺桡关节(DRUJ)功能障碍有多种治疗方法。本研究旨在评估 Darrach 和 Sauvé-Kapandji 手术治疗创伤后 DRUJ 紊乱的患者在身体功能、疼痛和满意度方面的长期患者报告结局的差异。次要目的是描述放射学结果,并评估这两种手术的并发症和再手术的发生率和类型差异。

我们回顾性分析了 85 例创伤后 DRUJ 紊乱患者,其中 57 例行 Darrach 手术,28 例行 Sauvé-Kapandji 手术。52 例患者(61%)在手术后中位数为 8.4 年时完成了患者报告的结局调查。放射学测量包括尺侧距离、桡尺距离和尺侧间隙(仅 Sauvé-Kapandji 组)。Darrach 手术组和 Sauvé-Kapandji 手术组的患者报告的结局测量信息系统(PROMIS)上肢(UE)功能评分、疼痛评分、满意度评分、并发症和再手术无显著差异。Darrach 组有 17 例(30%)患者发生并发症,Sauvé-Kapandji 组有 14 例(50%)患者发生并发症(=0.09)。最常见的并发症是尺骨残端不稳定(n=10),其次是尺神经背侧感觉支症状(n=8)。行 Sauvé-Kapandji 手术的患者因异位骨化切除而再次手术的比例更高。

在治疗创伤后 DRUJ 功能障碍方面,Darrach 和 Sauvé-Kapandji 手术显示出相当的长期患者报告结局。并发症和再手术的发生率都相对较高,但两种手术之间无显著差异。

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