Department of Hand and Upper Extremity Surgery, Peripheral Nerves Surgery, Lapeyronie University Hospital of Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile-Gallé, University Hospital of Nancy, 49, rue Hermite, 54000 Nancy, France.
Department of Hand and Upper Extremity Surgery, Peripheral Nerves Surgery, Lapeyronie University Hospital of Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
Hand Surg Rehabil. 2020 Oct;39(5):375-382. doi: 10.1016/j.hansur.2020.05.002. Epub 2020 May 18.
The aim of this study was to assess the clinical and radiographic outcomes after radioscapholunate (RSL) fusion for posttraumatic osteoarthritis. This was a retrospective, dual-center study of all patients who underwent RSL fusion between 1995 and 2015 for posttraumatic radiocarpal osteoarthritis. Patients were assessed at the final review to determine clinical (pain, wrist range of motion and strength), self-reported (QuickDASH, PRWE and MWS scores) and radiological (degenerative osteoarthritis in the scaphotrapeziotrapezoid (STT) or midcarpal joint and radiocarpal fusion) outcomes. We analyzed three groups: RSL fusion alone, RSL fusion with distal scaphoid excision (DSE) and RSL fusion with DSE and triquetrum excision (TE). Eighty-five patients were included; 10 were lost to follow-up and 11 required conversion to total wrist fusion before the final review. Finally, 64 patients had both clinical and radiographic evaluations. The mean follow-up was 9.1 years (range 1-21.4). RSL fusion alone was performed in 29 patients, RSL fusion with DSE in 23 and RSL fusion with DSE and TE in 12. At the final follow-up, the three groups did not differ in their pain or wrist motion. Overall, 47 (73%) patients were satisfied or very satisfied with the procedure. DSE significantly decreased STT osteoarthritis and radiocarpal non-union. The total wrist osteoarthritis rate after RSL fusion was 55%. RSL fusion is an effective procedure to preserve some motion in wrists with posttraumatic radiocarpal osteoarthritis. DSE prevents STT osteoarthritis by removing bony impingement and increases the fusion rate. LEVEL OF EVIDENCE: Level IV, Case series, Therapeutic studies.
本研究旨在评估创伤后关节炎行桡腕关节融合术后的临床和影像学结果。这是一项回顾性的、双中心研究，纳入了 1995 年至 2015 年间因创伤后腕骨关节炎行桡腕关节融合术的所有患者。在最终随访时评估患者的临床（疼痛、腕关节活动度和力量）、自我报告（QuickDASH、PRWE 和 MWS 评分）和影像学（舟月三角骨或腕中关节退行性骨关节炎和腕骨融合）结果。我们分析了三组：单纯桡腕关节融合术（RSL）、RSL 联合舟骨远端切除（DSE）和 RSL 联合 DSE 及三角骨切除（TE）。共纳入 85 例患者，10 例失访，11 例在最终随访前需改行全腕关节融合术。最终，64 例患者同时进行了临床和影像学评估。平均随访时间为 9.1 年（1-21.4 年）。单纯 RSL 融合术 29 例，RSL 联合 DSE 23 例，RSL 联合 DSE 和 TE 12 例。在最终随访时，三组患者的疼痛和腕关节活动度无差异。总体而言，47 例（73%）患者对手术过程满意或非常满意。DSE 可显著降低舟月三角骨关节炎和桡腕关节不愈合。RSL 融合术后全腕关节炎发生率为 55%。RSL 融合术是治疗创伤后桡腕关节炎保留部分腕关节活动度的有效方法。DSE 通过去除骨撞击来预防舟月三角骨关节炎，并增加融合率。证据等级：IV 级，病例系列，治疗性研究。
