Cheung Lok Ka, Smock Elliott, Pickford Mark
Department of Plastic Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, RH193DZ, UK.
J Surg Case Rep. 2021 Jul 22;2021(7):rjab296. doi: 10.1093/jscr/rjab296. eCollection 2021 Jul.
A 50-year-old, right-hand dominant woman presented with a seven-month history of stiffness, pain and swelling on the ulnar side of her right wrist. She had undergone right wrist arthroplasty with a Pyrocarbon Amandys implant seven months previously for post-traumatic degenerative arthritis. She had an uneventful initial recovery until developing carpal tunnel syndrome, for which she underwent carpal tunnel release 5 months after her arthroplasty. Examination revealed a painful and limited range of movement in the affected wrist, with weakness of the first dorsal interosseous muscle and altered sensation in the ring finger. A hard swelling was visible and palpable on the palmar-ulnar aspect of the wrist. X-rays showed that the swelling was due to the dislocated Amandys implant (which was thought to be causing compression neuropathy of the ulnar nerve). The patient underwent removal of the pyrocarbon implant (through a palmar approach) and total wrist fusion one month later, following which the wrist successfully united and all symptoms of ulnar nerve compression resolved. Although some studies have reported migration of pyrocarbon implant following total wrist arthroplasty, to our knowledge, this is the first reported case of ulnar compression neuropathy from a migrated pyrocarbon wrist implant.
一名50岁、惯用右手的女性，出现右手腕尺侧僵硬、疼痛和肿胀7个月。7个月前，她因创伤后退行性关节炎接受了使用Pyrocarbon Amandys植入物的右手腕关节成形术。术后初期恢复顺利，但随后出现腕管综合征，为此她在关节成形术后5个月接受了腕管松解术。检查发现患侧手腕疼痛且活动范围受限，第一背侧骨间肌无力，无名指感觉改变。在手腕掌侧尺侧可见并可触及硬性肿胀。X线显示肿胀是由于Amandys植入物脱位（据认为这导致了尺神经压迫性神经病变）。1个月后，患者接受了（经掌侧入路）热解碳植入物取出术及全腕关节融合术，术后手腕成功愈合，尺神经压迫的所有症状均消失。尽管一些研究报道了全腕关节成形术后热解碳植入物的移位，但据我们所知，这是首例因热解碳手腕植入物移位导致尺神经压迫性神经病变的病例报告。
