用肋软骨膜重建桡尺远侧关节-中期随访。
Reconstruction of the distal radioulnar joint with rib perichondrium - midterm follow-up.
机构信息
Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University, Entrance 70, 1st floor, 751 85, Uppsala, Sweden.
Department of Orthopedics, Falu Lasarett, Lasarettsvägen 10, 791 82, Falun, Sweden.
出版信息
BMC Musculoskelet Disord. 2022 Apr 26;23(1):388. doi: 10.1186/s12891-022-05335-4.
BACKGROUND
Reconstruction of an osteoarthritic distal radioulnar joint (DRUJ) in patients with high physical demands and a long lifetime expectancy is challenging. A variety of methods like implant surgery and salvage procedures as partial or total ulnar head resection and the Sauve-Kapandji procedure are reasonable options in the elderly patient but not in young individuals since it often compromises manual power and stability and may cause impingement problems. Reconstruction of the DRUJ with rib perichondrium is a new treatment option with promising short-term outcome. The aim the present study was to investigate if the outcome is consistent over time.
METHODS
Four female patients with a mean age of 40.5 years suffered severe unilateral osteoarthritis in the DRUJ. They underwent reconstruction of the joint with rib perichondrium transplants. Preoperatively, mean pain under manual load was 8.5 (range 7-10) and 4.2 (range 2-5) at rest, using the visual analogue scale (VAS). Range of motion (ROM) in forearm rotation was on average 118° and grip strength was 86% in comparison to the contralateral hand. The outcome was assessed at a clinical follow-up in 2016, measuring ROM, grip-strength, pain at rest and under manual load and DASH-score. Radiological examination was performed. An additional follow-up by letter was performed in 2021 using a patient-reported-outcome survey (PROS). The patients were asked to grade the ROM and grip-strength as changed or unchanged in comparison to the clinical follow-up in 2016.
RESULTS
At clinical follow-up at a mean of 3.1 years (range 1-5) after surgery, pain level had decreased to VAS 1.5 (0-5) under load and all patients were pain free at rest. Forearm rotation was on average 156° (range 100-180) and grip strength was 97% of the unoperated hand. The mean DASH-score was 14.4 (0-45). An additional follow-up by letter was conducted at a mean of 7.5 years (5.5-9.5) after surgery. ROM and grip strength were reported as unchanged by all patients in relation to the previous clinical follow-up. No additional surgery or complications were reported.
CONCLUSION
Reconstruction of the osteoarthritic DRU-joint with rib perichondrium transplantation can provide good clinical outcome with perseverance over time.
LEVEL OF EVIDENCE
IV.
背景
对于高体力需求和预期寿命长的患者，重建骨关节炎桡尺远侧关节（DRUJ）具有挑战性。各种方法，如植入物手术和挽救性手术，如部分或全部尺骨头切除术和 Sauve-Kapandji 手术，在老年患者中是合理的选择，但在年轻患者中并非如此，因为它通常会影响手部力量和稳定性，并可能导致撞击问题。用肋软骨膜重建 DRUJ 是一种新的治疗选择，具有有前途的短期结果。本研究的目的是研究随着时间的推移，结果是否一致。
方法
4 名平均年龄 40.5 岁的女性患者，单侧 DRUJ 严重骨关节炎。他们接受了肋软骨膜移植物重建关节。术前，在手动负荷下，平均疼痛为 8.5（7-10），在休息时为 4.2（2-5），使用视觉模拟量表（VAS）。前臂旋转的平均活动范围（ROM）为 118°，握力与对侧手相比为 86%。2016 年进行临床随访时评估结果，测量 ROM、握力、休息时和手动负荷下的疼痛以及 DASH 评分。进行了影像学检查。2021 年通过信函进行了额外的随访，使用患者报告的结果调查（PROS）。患者被要求将 ROM 和握力与 2016 年的临床随访进行比较，评估为改善或无变化。
结果
在手术平均 3.1 年后（1-5 年）的临床随访中，疼痛程度已降至 VAS 1.5（0-5），负荷下所有患者均无疼痛。前臂旋转平均为 156°（100-180），握力为未手术手的 97%。平均 DASH 评分为 14.4（0-45）。手术平均 7.5 年后（5.5-9.5 年）进行了额外的信函随访。所有患者均报告 ROM 和握力与之前的临床随访相比无变化。没有进行额外的手术或报告并发症。
结论
用肋软骨膜移植重建骨关节炎 DRUJ 可以提供良好的临床效果，并随着时间的推移保持持久。
证据水平
IV。
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