Förster W, Schlegel E
Klinik für Hand- und plastisch-wiederherstellende Chirurgie der Unfallklinik des Friederikenstiftes Hannover.
Handchir Mikrochir Plast Chir. 1988 Nov;20(6):306-13.
Eighty-nine late results (five to twelve years follow-up) of prosthetic replacement of the scaphoid bone with a silastic spacer are presented. In 76% the clinical course was uncomplicated; 24% needed secondary surgical procedures including two arthrodeses of the wrist joint. Flexion and extension of the wrist improved by 10.9%, radial and ulnar deviation by 15.0% on average. The first carpometacarpal joint showed minor restriction in 24.0%. The power grip was diminished by 32.0%, the lateral pinch by 25.0% on average. In 43.0% of the cases development or increase of intraosseous cysts was noticed, most of the patients being free of symptoms. Potential underlying factors were investigated. The silastic material seems not to have had any influence. Only slight advancement of the osteoarthritis was found and in some cases the process was arrested. The prostheses were adequately centered in 77.0%, slightly displaced in 16.0%, and dislocated in 7.0%. Change of intracarpal angles is largely complete by the fifth year. In the majority of cases signs of dorsal instability are obvious. The angle between the scaphoid and lunate is generally increased. The height of the carpus is diminished by 1.7 mm, and the distance between the trapezium and the lunate by 3.7 mm in average. A new score is presented which puts more stress on objective results and the clinical course than on complaints of the patient. Because of the predominantly good results (65%) the prosthetic replacement with a silastic spacer is favoured against other palliative techniques.
本文报告了89例采用硅橡胶间隔物进行舟骨假体置换的远期结果（随访5至12年）。76%的患者临床过程顺利；24%的患者需要二次手术，包括两次腕关节融合术。腕关节的屈伸平均改善了10.9%，桡偏和尺偏平均改善了15.0%。第一腕掌关节有24.0%出现轻度受限。握力平均下降了32.0%，侧捏力平均下降了25.0%。43.0%的病例发现有骨内囊肿形成或增大，大多数患者无症状。对潜在的相关因素进行了研究。硅橡胶材料似乎没有任何影响。仅发现骨关节炎有轻微进展，在某些情况下病情得到了控制。假体位置合适的占77.0%，轻度移位的占16.0%，脱位的占7.0%。腕骨内角度的变化在第5年基本完成。大多数病例中背侧不稳定的体征明显。舟骨与月骨之间的角度通常增大。腕骨高度平均降低1.7mm，大多角骨与月骨之间的距离平均缩短3.7mm。提出了一种新的评分系统，该系统更注重客观结果和临床过程，而非患者的主诉。由于主要结果良好（65%），与其他姑息治疗技术相比，采用硅橡胶间隔物的假体置换更受青睐。
