Quadlbauer Stefan, Leixnering Martin, Rosenauer Rudolf, Jurkowitsch Josef, Hausner Thomas, Pezzei Christoph
AUVA Unfallkrankenhaus Lorenz Böhler - European Hand Trauma Center, 1200, Wien, Österreich.
Ludwig Boltzmann Institut für Experimentelle und Klinische Traumatologie, AUVA Research Center, 1200, Wien, Österreich.
Oper Orthop Traumatol. 2020 Oct;32(5):455-466. doi: 10.1007/s00064-020-00651-1. Epub 2020 Feb 25.
Radioscapholunate (RSL) arthrodesis with distal scaphoidectomy using an angular stable plate and palmar access in post-traumatic or degenerative osteoarthritis limited to the radiocarpal joint.
Osteoarthritis limited to the radiocarpal joint with intact mediocarpal joint after malunited intra-articular distal radius fractures, rheumatoid osteoarthritis, scapholunate advanced collapse (SLAC) up to stage II.
Mediocarpal osteoarthritis, poor patient compliance, SLAC from stage III, osteitis.
The palmar RSL arthrodesis is performed using the palmar approach between the flexor carpi radialis tendon and the radial artery. After releasing the pronator quadratus muscle, a longitudinal capsulotomy is performed and the radiocarpal joint is inspected. After correction of a volar or dorsal intercalated segmental instability of the lunate, the lunate is temporarily fixed to the scaphoid using a K-wire. The distal quarter of the scaphoid and the palmar rim of the distal radius is resected and the cartilage between the scaphoid, lunate and distal radius is removed. The scaphoid and lunate are temporarily fixed to the distal radius using K‑wires. Under image intensifier control the angular stable low-profile plate (e.g., volar 2.5 Trilock RSL Fusion plate [Medartis® Aptus® Basel, Switzerland]) is fixed to the distal radius in the long-leg hole. The scaphoid and lunate are fixed distally with two screws each. The carpus is pushed distally using a Codeman distractor and the cancellous bone graft is impacted. Finally, the shaft is fixed with angular stable screws.
Immobilization using a plaster cast or thermoplastic short-arm orthosis for 5 weeks. After 2 weeks, the orthosis can be removed during hand therapy with active wrist and finger exercises. Normal activities permitted after 12 weeks.
Palmar RSL arthrodesis and distal scaphoidectomy using angular stable plate fixation shows a high union rate and pain relief while maintaining good residual mobility of the wrist.
采用角稳定钢板及掌侧入路行桡舟月关节融合术并切除舟骨远端，用于治疗局限于桡腕关节的创伤后或退行性骨关节炎。
桡骨远端关节内骨折畸形愈合后，局限于桡腕关节且中腕关节完整的骨关节炎；类风湿性骨关节炎；舟月关节高级塌陷（SLAC）至II期。
中腕关节骨关节炎；患者依从性差；III期SLAC；骨炎。
采用掌侧入路，在桡侧腕屈肌腱与桡动脉之间进行掌侧桡舟月关节融合术。松解旋前方肌后，进行纵行关节囊切开并检查桡腕关节。纠正月骨掌侧或背侧嵌入节段性不稳定后，用克氏针将月骨临时固定于舟骨。切除舟骨远端四分之一及桡骨远端掌侧边缘，并去除舟骨、月骨与桡骨远端之间的软骨。用克氏针将舟骨和月骨临时固定于桡骨远端。在影像增强器控制下，将角稳定低轮廓钢板（如掌侧2.5 Trilock桡舟月融合钢板[Medartis® Aptus®，瑞士巴塞尔]）通过长孔固定于桡骨远端。舟骨和月骨分别用两枚螺钉向远端固定。使用Codeman撑开器将腕骨向远端推，然后嵌入松质骨移植块。最后，用角稳定螺钉固定骨干。
使用石膏或热塑性短臂矫形器固定5周。2周后，在手部治疗期间，主动进行腕关节和手指活动时可拆除矫形器。12周后允许进行正常活动。
采用角稳定钢板固定的掌侧桡舟月关节融合术及舟骨远端切除术显示融合率高，可缓解疼痛，同时保持腕关节良好的残余活动度。
