Department of Hand and Wrist Surgery, Maasstad Hospital Rotterdam, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
Oper Orthop Traumatol. 2023 Dec;35(6):341-351. doi: 10.1007/s00064-023-00822-w. Epub 2023 Aug 2.
To describe the indications, operative technique, and long-term outcomes of patients treated with the Scheker (Aptis) distal radio-ulnar joint (DRUJ) prosthesis.
The Scheker prosthesis is intended to replace the DRUJ in patients with rheumatoid, degenerative, or posttraumatic arthritis of the sigmoid notch and/or ulnar head, or in cases of gross instability of the DRUJ. Moreover, a Scheker prosthesis can be used to treat failed salvage procedures, such as the Sauvé-Kapandji procedure, ulnar head resection, and ulnar head arthroplasty.
Severe osteoporosis, active infection, immature skeleton, less than 14 cm of the proximal ulna remaining.
In supine position with the forearm in full pronation, an ulnar S‑shaped incision is made. The ulnar head is resected and the proximal part is brought to the palmar side to enable visualization of the sigmoid notch. Following preparation of the sigmoid notch and the proximal ulnar part of the radius, a radial plate is attached. When the position is verified with fluoroscopy, screw holes are drilled together with a separate hole for the radial peg. A metal stem is inserted in the ulnar shaft. A polymer ball is then slid on to a polished peg on top of the ulnar stem. This polymer ball is seated in the socket of the radial plate and fixed with a small metal cap. Radiographic images are made for confirmation of correct positioning and full pro- and supination is tested, after which the wound is closed.
After 48 h of pressure bandages, patients are instructed to start with full range of motion and weight-bearing exercises under the guidance of a hand therapist. Weight-bearing is constrained to 10 kg.
We retrospectively assessed 50 Scheker prostheses in 48 patients treated between 2016 and 2021. The median age was 56 years (IQR: 50-65) and 30 (60%) were female. Median follow-up was 29 months (IQR: 12-48). The primary outcome was the PRWE score. The median PRWE score at the final follow-up was 23 (IQR: 4-52) for the operated side versus a median PRWE score of 5 (IQR: 0-25) for the non-operated side (p < 0.005). Six patients had a complication. Three patients developed extensor carpi ulnaris tendinitis with one patient requiring additional surgery. One patient developed a neuroma of the distal branch of the ulnar nerve that was surgically removed. One synovectomy was performed because of synovitis and one endoscopic ulnar release was performed because of hyperesthesia of the ulnar area. None of the prostheses had to be removed.
描述使用 Scheker（Aptis）远端桡尺关节（DRUJ）假体治疗的患者的适应证、手术技术和长期结果。
Scheker 假体旨在替代患有类风湿关节炎、退行性关节炎或创伤后关节炎的患者的 DRUJ 的月状骨窝和/或尺骨头，或在 DRUJ 严重不稳定的情况下。此外，Scheker 假体可用于治疗 Sauvé-Kapandji 手术、尺骨头切除和尺骨头关节成形术等失败的挽救手术。
严重骨质疏松症、活动性感染、未成熟骨骼、尺骨近端少于 14 厘米。
患者仰卧，前臂完全旋前，行尺骨 S 形切口。切除尺骨头，并将其近端带到掌侧，以便能够观察到月状骨窝。准备好月状骨窝和桡骨近端后，安装桡骨板。透视验证位置后，与单独的桡骨钉孔一起钻螺丝孔。将金属柄插入尺骨干。然后将聚合物球滑到尺骨干顶部的抛光钉上。聚合物球位于桡骨板的承窝中，并通过一个小金属帽固定。拍摄影像学图像以确认正确的位置，并测试完全掌屈和背屈，然后关闭伤口。
压力绷带 48 小时后，在手部治疗师的指导下，指导患者开始进行全范围的运动和负重锻炼。负重限制为 10 公斤。
我们回顾性评估了 2016 年至 2021 年间治疗的 48 名患者的 50 个 Scheker 假体。中位年龄为 56 岁（IQR：50-65），30 名（60%）为女性。中位随访时间为 29 个月（IQR：12-48）。主要结果是 PRWE 评分。末次随访时，患侧的中位数 PRWE 评分为 23（IQR：4-52），非患侧的中位数 PRWE 评分为 5（IQR：0-25）（p<0.005）。6 名患者出现并发症。3 名患者发生尺侧腕伸肌肌腱炎，其中 1 名患者需要额外手术。1 名患者发生尺神经远端分支神经瘤，手术切除。1 例行滑膜切除术，1 例行内镜下尺侧松解术，因为尺侧区域感觉过敏。没有一个假体需要取出。
