Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, 37000 Tours, France.
Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques, centre hospitalo-universitaire Tours, université de médecine de Tours François-Rabelais, 37000 Tours, France.
Orthop Traumatol Surg Res. 2021 Sep;107(5):102974. doi: 10.1016/j.otsr.2021.102974. Epub 2021 Jun 1.
In distal radioulnar joint pathology, the literature regularly recommends reserving the Sauvé-Kapandji (SK) procedure to young patients and heavy manual workers, and the Darrach (D) procedure to older patients and rheumatic wrists. However, the SK procedure is more technically demanding and requires more proximal resection of the ulna, with greater risk of instability in the ulnar stump. The aim of the present study was to determine whether the SK procedure really does show superiority.
Subjective results are no better after the SK than the D procedure.
Seventy of the 101 operated cases (70 patients: 40 female, 30 male; mean age at surgery, 50.2 years [range, 16.4-87.2 years]) were assessed, at a minimum 24 months. Group D comprised 44 wrists, and group SK 26. Assessment was conducted by telephone interview for pain, ranges of flexion-extension and pronation-supination, strength, stump stability and satisfaction, and by mail for the QuickDASH questionnaire. Mean follow-up was 8.2 years (range, 25 months to 17 years).
The surgical revision rate was significantly higher in SK (p=0.003). Results were comparable between groups for pain, strength, range of motion and satisfaction. Mean QuickDASH score was 45.5 in group D and 26.5 in group SK. Age-matched comparison found no significant differences on endpoints.
Subjective results after the SK procedure showed no superiority over the D procedure, despite group D patients having twice the rate of heavy manual work and sport activities. This non-difference casts doubt on the need to reserve the D procedure to elderly patients and the SK procedure to young patients and heavy manual workers, especially as the latter is more technically demanding and is associated with a higher rate of surgical revision.
IV; retrospective study.
在远端桡尺关节病变中，文献通常建议将 Sauvé-Kapandji（SK）手术保留给年轻患者和重体力劳动者，将 Darrach（D）手术保留给老年患者和风湿性手腕患者。然而，SK 手术技术要求更高，需要对尺骨进行更靠近近端的切除，尺骨残端不稳定的风险更大。本研究旨在确定 SK 手术是否真的具有优势。
SK 手术后的主观结果并不优于 D 手术后的结果。
对 101 例手术病例中的 70 例（70 例患者：40 例女性，30 例男性；手术时的平均年龄为 50.2 岁[范围，16.4-87.2 岁]）进行了评估，随访时间至少为 24 个月。D 组包括 44 例腕关节，SK 组包括 26 例。通过电话访谈评估疼痛、屈伸和旋前-旋后范围、力量、残端稳定性和满意度，并通过邮件评估 QuickDASH 问卷。平均随访时间为 8.2 年（范围，25 个月至 17 年）。
SK 组的手术翻修率显著更高（p=0.003）。两组在疼痛、力量、活动范围和满意度方面的结果相当。D 组的平均 QuickDASH 评分为 45.5，SK 组为 26.5。年龄匹配的比较发现，两组在终点方面没有显著差异。
SK 手术后的主观结果并不优于 D 手术，尽管 D 组患者的重体力劳动和运动活动比例是 SK 组的两倍。这种无差异质疑了将 D 手术保留给老年患者和 SK 手术保留给年轻患者和重体力劳动者的必要性，尤其是因为后者技术要求更高，手术翻修率更高。
IV；回顾性研究。
