Dittman Lauren E, Shin Alexander Y, Rhee Peter C
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Clinical Investigation Facility, Travis Air Force Base, California.
J Wrist Surg. 2022 Dec 8;12(4):295-300. doi: 10.1055/s-0042-1759687. eCollection 2023 Aug.
Concomitant severe radiocarpal (RC) arthritis with asymptomatic or minimally symptomatic distal radioulnar joint (DRUJ) arthritis can be debilitating for patients. Surgical management of these combined arthritides can pose a dilemma for surgeons and patients. The purpose of this study was to evaluate patients with concomitant RC and DRUJ arthritides who underwent only total wrist arthrodesis (TWA) to determine the need for subsequent surgical management of preoperative asymptomatic/minimally symptomatic DRUJ arthritis. All patients who underwent TWA between 2008 and 2018 at a single institution were evaluated. Those patients who underwent TWA for degenerative, inflammatory, or posttraumatic arthritis with concomitant asymptomatic or minimally symptomatic DRUJ arthritis preoperatively were included. A retrospective review was performed for demographic variables, TWA indications, pre- versus post-TWA DRUJ symptoms, and severity of DRUJ arthritis on radiographs. Primary outcome measure was survivorship from subsequent DRUJ surgery for development of symptomatic arthritis after initial TWA. One hundred and eighty-three patients underwent TWA during the study period, of which 39 wrists met inclusion criteria. Indications for TWA included posttraumatic arthritis ( = 22), avascular necrosis of the lunate ( = 10), and inflammatory arthritis ( = 7). The mean clinical follow-up was 5.7 years (range: 1.5-12.7 years). Four patients (10%) who underwent TWA ultimately required a subsequent procedure to address DRUJ arthritis at a mean time of 20 months (range: 3-60 months) after initial TWA. The initial indication for TWA in these patients included symptomatic posttraumatic arthritis ( = 3) and lunate avascular necrosis ( = 1). In patients with symptomatic RC and asymptomatic or minimally symptomatic DRUJ arthritides undergoing TWA alone, 10% in this series required subsequent surgical management for progressive DRUJ arthritis. Surgical management of concomitant symptomatic RC and asymptomatic/minimally symptomatic DRUJ arthritides with TWA alone is a reasonable initial approach. Patients should be counseled preoperatively that subsequent surgical management of progressive DRUJ arthritis may be necessary in ∼10% of patients.
伴有严重桡腕（RC）关节炎且尺桡远侧关节（DRUJ）关节炎无症状或症状轻微的情况，可能会使患者虚弱。这些合并关节炎的手术治疗可能给外科医生和患者带来两难境地。本研究的目的是评估仅接受全腕关节融合术（TWA）的RC和DRUJ合并关节炎患者，以确定对术前无症状/症状轻微的DRUJ关节炎进行后续手术治疗的必要性。
对2008年至2018年在单一机构接受TWA的所有患者进行评估。纳入那些术前因退行性、炎症性或创伤后关节炎合并无症状或症状轻微的DRUJ关节炎而接受TWA的患者。对人口统计学变量、TWA指征、TWA前后的DRUJ症状以及X线片上DRUJ关节炎的严重程度进行回顾性分析。主要结局指标是初次TWA后因症状性关节炎发展而接受后续DRUJ手术的生存率。
在研究期间，183例患者接受了TWA，其中39例腕关节符合纳入标准。TWA的指征包括创伤后关节炎（n = 22）、月骨缺血性坏死（n = 10）和炎症性关节炎（n = 7）。平均临床随访时间为5.7年（范围：1.5 - 12.7年）。4例（10%）接受TWA的患者最终需要在初次TWA后平均20个月（范围：3 - 60个月）进行后续手术以治疗DRUJ关节炎。这些患者初次TWA的指征包括症状性创伤后关节炎（n = 3）和月骨缺血性坏死（n = 1）。
在仅接受TWA的有症状RC和无症状或症状轻微的DRUJ关节炎患者中，本系列中有10%的患者因进行性DRUJ关节炎需要后续手术治疗。
仅采用TWA对有症状的RC和无症状/症状轻微的DRUJ合并关节炎进行手术治疗是一种合理的初始方法。术前应告知患者，约10%的患者可能需要对进行性DRUJ关节炎进行后续手术治疗。
