Bartoletta John J, Rioux-Forker Dana, Patel Raahil S, Hinchcliff Katharine M, Shin Alexander Y, Rhee Peter C
Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Clinical Investigation Facility, Travis Air Force Base, California.
J Wrist Surg. 2021 Dec 24;11(4):344-352. doi: 10.1055/s-0041-1740400. eCollection 2022 Aug.
Some surgeons advocate for concomitant proximal row carpectomy (PRC) with total wrist arthrodesis (TWA), though there are limited data to support or oppose this view. Does concomitant PRC improve rates of union, revision, hardware loosening, hardware failure, and hardware removal in TWA? A retrospective cohort study of patients who underwent TWA with and without concomitant PRC between January 2008 and December 2018 was undertaken. Patients were included if they underwent TWA using a dorsal spanning plate. Patients were excluded if they underwent partial wrist arthrodesis, revision TWA, or TWA with nondorsal spanning plate fixation. A total of 183 wrists in 180 patients were included in the study, 96 (52.5%) in the TWA only and 87 (47.5%) in the TWA + PRC groups. Median clinical and radiographic follow-up was 18.0 months (3.0-133.0 months) in the TWA + PRC group and 18.5 months (2.0-126.0 months) in the TWA only group ( = 0.907). No difference in nonunion (TWA + PRC: 13/87 [14.9%], TWA only: 18/96 [18.8%], odds ratio: 0.76, = 0.494), revision (TWA + PRC: 5/87 [5.75%], TWA only: 8/96 [8.33%], hazard ratio [HR]: 0.73, = 0.586), loosening (TWA + PRC: 4/87 [4.60%], TWA only: 6/96 [6.25%], HR: 0.74, = 0.646), failure (TWA + PRC: 5/87 [5.75%], TWA only: 4/96 [4.17%], HR: 1.55, = 0.530), and removal (TWA + PRC: 12/87 [13.8%], TWA only: 16/96 [16.7%], HR: 0.84, = 0.634) were identified. Concomitant PRC might not improve rates of union or diminish complications in patient undergoing TWA. The role of PRC and the rationale for its use in TWA need to be individualized and discussed with patients prior to surgery. This is a Level IV, therapeutic study.
一些外科医生主张在全腕关节融合术（TWA）的同时进行近端排腕骨切除术（PRC），不过支持或反对这一观点的数据有限。在TWA中同时进行PRC是否能提高融合率、翻修率、内固定松动率、内固定失败率以及内固定取出率？对2008年1月至2018年12月期间接受或未接受同期PRC的TWA患者进行了一项回顾性队列研究。如果患者使用背侧跨越钢板进行TWA，则纳入研究。如果患者接受了部分腕关节融合术、翻修性TWA或使用非背侧跨越钢板固定的TWA，则排除在外。该研究共纳入了180例患者的183个腕关节，仅TWA组96个（52.5%），TWA + PRC组87个（47.5%）。TWA + PRC组的临床和影像学中位随访时间为18.0个月（3.0 - 133.0个月），仅TWA组为18.5个月（2.0 - 126.0个月）（P = 0.907）。未发现骨不连（TWA + PRC组：13/87 [14.9%]，仅TWA组：18/96 [18.8%]，比值比：0.76，P = 0.494）、翻修（TWA + PRC组：5/87 [5.75%]，仅TWA组：8/96 [8.33%]，风险比[HR]：0.73，P = 0.586）、松动（TWA + PRC组：4/87 [4.60%]，仅TWA组：6/96 [6.25%]，HR：0.74，P = 0.646）、失败（TWA + PRC组：5/87 [5.75%]，仅TWA组：4/96 [4.17%]，HR：1.55，P = 0.530）和取出（TWA + PRC组：12/87 [13.8%]，仅TWA组：16/96 [16.7%]，HR：0.84，P = 0.634）方面存在差异。在接受TWA的患者中，同期PRC可能无法提高融合率或减少并发症。PRC在TWA中的作用及其使用的基本原理需要个体化，并在手术前与患者进行讨论。这是一项IV级治疗性研究。
