Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan; Department of Orthopaedic Surgery, NTT Medical Center Sapporo, Chuo-ku, Sapporo, Japan.
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
J Hand Surg Am. 2024 Sep;49(9):929.e1-929.e9. doi: 10.1016/j.jhsa.2022.11.014. Epub 2023 Jan 7.
This study aimed to determine the results of radiolunate arthrodesis for rheumatoid arthritis (RA) after a long-term follow-up period of up to 20 years under tight postoperative medical control of RA. We also compared the results between patients with and without degenerative changes in the midcarpal joints at follow-up. We determined the radiologic factors predictive of secondary degenerative changes in the midcarpal joint.
This was a long-term retrospective analysis of 16 wrists of 14 patients with RA treated with radiolunate arthrodesis first reported in 2013. The mean follow-up period was 14 years (range, 8-23 years; SD, 4.6 years). Ten wrists had a Larsen classification of grade III, whereas 6 wrists had grade IV. The range of motion was assessed, and clinical outcomes were graded using the Mayo Wrist Score and Stanley classification system. The Carpal Height Index, Ulnar Translation Index, and changes in the midcarpal joint contour were determined from radiographs. We categorized the changes in the midcarpal joint as unchanged or degenerative.
At final follow-up, the clinical scores improved; however, the extension and flexion range of motion was significantly reduced compared with that before surgery. The Carpal Height Index and Ulnar Translation Index improved immediately after surgery and remained stable at final follow-up. The changes in the midcarpal joint were categorized as unchanged in 6 wrists and degenerative in 10 wrists. The clinical outcomes were similar between the groups. The mean preoperative Ulnar Translation Index was significantly higher in the degenerative group than in the unchanged group.
Radiolunate arthrodesis in patients with RA maintained good clinical results and corrected alignment, even during long-term follow-up. Preoperative severe ulnar translation deformity was a risk factor for postoperative degeneration of the midcarpal joint, and pre-existing degenerative changes at the midcarpal joint might lead to loss of wrist range of motion.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在探讨在严格的术后类风湿关节炎（RA）医疗控制下，对长达 20 年的长期随访期内，桡月关节融合术治疗类风湿关节炎的结果。我们还比较了随访时腕中关节有无退行性改变的患者之间的结果。我们确定了预测腕中关节继发性退行性改变的影像学因素。
这是对 2013 年首次报道的 14 例 RA 患者的 16 例腕关节进行的长期回顾性分析。平均随访时间为 14 年（范围 8-23 年；标准差 4.6 年）。10 例腕关节的 Larsen 分级为 III 级，而 6 例为 IV 级。评估了关节活动度，并使用 Mayo 腕关节评分和 Stanley 分类系统对临床结果进行分级。从 X 线片确定腕骨高度指数、尺侧移位指数和腕中关节轮廓的变化。我们将腕中关节的变化分为不变或退行性。
末次随访时，临床评分有所改善；然而，与术前相比，伸展和屈曲活动度明显减少。腕骨高度指数和尺侧移位指数在手术后即刻改善，并在最终随访时保持稳定。腕中关节的变化在 6 例中归类为不变，在 10 例中归类为退行性。两组间的临床结果相似。退行性组的术前尺侧移位指数明显高于不变组。
RA 患者的桡月关节融合术即使在长期随访中，也能保持良好的临床效果和矫正对线。术前严重的尺侧移位畸形是术后腕中关节退变的危险因素，而腕中关节的预先存在的退行性改变可能导致腕关节活动范围丧失。
研究类型/证据水平：治疗性 IV 级。
