Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France.
Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques SOS main, Montpellier, France.
Orthop Traumatol Surg Res. 2020 Dec;106(8):1597-1603. doi: 10.1016/j.otsr.2020.07.008. Epub 2020 Nov 5.
In palliative surgery on the distal radio-ulnar joint (DRUJ), ulnar head resection and the Sauvé-Kapandji procedure are often followed by instability and radio-ulnar convergence. The objective of this study was to evaluate the stability of the DRUJ after modified matched distal ulnar resection performed alone or with partial or complete wrist arthrodesis.
A modification of matched distal ulnar resection, consisting in reconstruction of the sixth compartment and dorsalisation of the extensor carpi ulnaris, minimises these complications, regardless of the cause and associated procedures.
A single-centre retrospective study was conducted in 46 patients (50 wrists) who underwent modified matched distal ulnar resection. The 50 wrists fell into three groups: total wrist arthrodesis according to Millender, n=21 (TWA group); radius to proximal row arthrodesis, n=17 (RPRA group); and isolated matched distal ulnar resection, n=12 (IMDUR group). Seventy per cent of patients had rheumatoid arthritis. Each patient underwent a clinical and radiographic assessment, with an analysis of radio-ulnar convergence, DRUJ stability, and ulno-carpal impingement, as well as of ulnar translation of the carpus in the IMDUR group.
After the mean follow-up of 8.2±5.4 years, 62% of patients were pain-free, with a mean VAS pain score of 1.3±2.1, and 90% of patients said they would have the procedure again. Clinical and radiographic instability due to excessively proximal resection was noted in 2 (4%) wrists, of which 1 required repeat surgery. Ulno-carpal impingement due to excessively distal resection occurred in 2 (4%) wrists. No significant ulnar translation of the carpus was noted in the IMDUR group (DiBenedetto: 0.011±1.9). Range of motion was similar in the three groups (mean pronation=77±17°; and mean supination=79±8°) (p>0.05). Mean grip strength was 85±35% compared to the other side.
Our modification of matched distal ulnar resection minimises the complications specific of other ulnar head resection techniques or of the Sauvé-Kapandji procedure, namely, radio-ulnar convergence and DRUJ instability.
IV; retrospective comparative study.
在手远端尺桡关节（DRUJ）的姑息性手术中，尺骨小头切除和 Sauvé-Kapandji 手术常常导致不稳定和桡尺骨会聚。本研究的目的是评估单独或联合部分或完全腕关节融合术进行改良匹配的远端尺骨切除后 DRUJ 的稳定性。
改良匹配的远端尺骨切除，包括第六间隙的重建和伸腕肌的背侧化，可减少这些并发症，而与病因和相关手术无关。
在 46 名患者（50 只腕关节）中进行了单中心回顾性研究，这些患者接受了改良匹配的远端尺骨切除。这 50 只腕关节分为三组：根据 Millender 进行的全腕关节融合术，n=21（TWA 组）；桡骨近排融合术，n=17（RPRA 组）；和单独的改良匹配的远端尺骨切除，n=12（IMDUR 组）。70%的患者患有类风湿关节炎。每位患者均进行临床和影像学评估，分析桡尺骨会聚、DRUJ 稳定性和尺腕撞击，以及 IMDUR 组的腕骨尺侧移位。
平均随访 8.2±5.4 年后，62%的患者无痛，平均 VAS 疼痛评分为 1.3±2.1，90%的患者表示会再次接受该手术。由于过度近侧切除导致的临床和影像学不稳定在 2 只（4%）腕关节中被发现，其中 1 只需要再次手术。由于过度远侧切除导致的尺腕撞击在 2 只（4%）腕关节中被发现。IMDUR 组未发现明显的腕骨尺侧移位（DiBenedetto：0.011±1.9）。三组的活动范围相似（平均旋前=77±17°；平均旋后=79±8°）（p>0.05）。握力平均为健侧的 85±35%。
我们对匹配的远端尺骨切除的改良减少了其他尺骨小头切除技术或 Sauvé-Kapandji 手术特有的并发症，即桡尺骨会聚和 DRUJ 不稳定。
IV；回顾性比较研究。
